Department of Neurology, University Hospitals of Geneva, rue Gabrielle Perret Gentil, 4, CH-1211 Geneva 14, Switzerland.
Joint Bone Spine. 2012 Jan;79(1):90-2. doi: 10.1016/j.jbspin.2011.07.008. Epub 2011 Oct 1.
Rheumatoid arthritis is well known for multiple extra-articular manifestations. Here, we present a case of chronic rheumatoid meningitis occurring during treatment with methotrexate and the tumour necrosis factor (TNF) alpha antibody adalimumab. Nine and seven months, respectively, into the course of these two treatments, a 59-year-old Caucasian lady with mild, early, seropositive rheumatoid arthritis developed headaches and psychomotor retardation followed by seizures. The diagnosis was confirmed by a brain biopsy showing a necrotizing granulomatous meningitis. Withdrawal of both drugs and high dose corticosteroids led to marked improvement. The addition of the anti-CD20 antibody rituximab allowed discontinuation of the corticosteroids. This is the fifth published case describing the occurrence of rheumatoid meningitis during treatment with TNF blockers. TNF blockers and methotrexate thus do not appear to prevent this complication, and may even contribute to its development.
类风湿关节炎以多种关节外表现而闻名。在这里，我们报告了一例在使用甲氨蝶呤和肿瘤坏死因子（TNF）α抗体阿达木单抗治疗期间发生的慢性类风湿性脑膜炎病例。在这两种治疗的第 9 个月和第 7 个月，一位 59 岁的高加索白人女性出现了轻度、早期、血清阳性的类风湿关节炎，随后出现头痛和运动迟缓，继而出现癫痫发作。脑部活检显示坏死性肉芽肿性脑膜炎，从而确诊了该疾病。停用这两种药物和大剂量皮质类固醇后，病情明显改善。加用抗 CD20 抗体利妥昔单抗后，皮质类固醇得以停用。这是第五个描述在使用 TNF 阻滞剂治疗期间发生类风湿性脑膜炎的病例。因此，TNF 阻滞剂和甲氨蝶呤似乎并不能预防这种并发症，甚至可能促成其发生。
