Is rheumatoid arthritis to blame for this patient’s oedema?

His fluid retention has stopped dissipating overnight
Echocardiogram intraoperative surgery

James is 65, and an amiable Scottish expatriate, who has had rheumatoid arthritis for more than 20 years.

He is clinically stable on weekly injections of methotrexate, which he self-administers. He attends every six months for review of his blood and urine tests.