title: Hypertrophic pachymeningitis in rheumatoid arthritis after adalimumab administration.
abstract: Tumor necrosis factor-a (TNF-a) inhibition, used in the treatment of rheumatoid arthritis (RA), is associated with central nervous system (CNS) events including new onset and/or exacerbations of pre-existing demyelinating neurological diseases. We describe a patient with refractory RA where adalimumab, a fully humanized IgG1 monoclonal antibody against TNF-a, may have contributed to the development of meningoencephalitis, with brain biopsy suggestive of hypertrophic pachymeningitis, a rare complication of this disease. The patient had recurrence of neurological symptoms upon repeated administration of adalimumab, and resolution of symptoms after withdrawal.
authors.affiliation: Division of Immunology, Department of Medicine, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Ahmed
authors.forename: Michael
authors.initials: M
authors.lastname: Luggen
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Herman
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Weiss
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Decourten-Myers
authors.forename: John G
authors.initials: JG
authors.lastname: Quinlan
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006651:Histocytochemistry; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000068879:Adalimumab; D011241:Prednisone