title: Induction of complete and sustained remission of rheumatoid pachymeningitis by rituximab.
abstract: Aseptic pachymeningitis is a rare and serious complication of rheumatoid arthritis (RA). Herein, we describe a patient with rheumatoid factor-positive and anti-cyclic citrullinated peptide-positive RA who experienced a focal seizure, with aphasia and convulsions of the right side of the body. The findings of magnetic resonance imaging and histologic analysis led to a diagnosis of rheumatoid pachymeningitis. Because the patient had a large number of CD20-expressing B lymphocytes, therapy with rituximab was started and has resulted in complete and sustained remission of both the pachymeningitis and the RA for >2 years. Despite a decrease in immunoglobulins, the patient has remained free of infections, which illustrates the favorable outcome that can result from therapeutic B cell depletion in this potentially lethal manifestation of RA.
authors.affiliation: Kantonsspital, Lucerne, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Schmid
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.forename: T
authors.initials: T
authors.lastname: Treumann
authors.forename: W
authors.initials: W
authors.lastname: Arnold
authors.forename: B
authors.initials: B
authors.lastname: Möller
authors.forename: D
authors.initials: D
authors.lastname: Aeberli
authors.forename: P M
authors.initials: PM
authors.lastname: Villiger
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000378:metabolism; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D001402:B-Lymphocytes / Q000276:immunology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D008875:Middle Aged; D012074:Remission Induction; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D018501:Antirheumatic Agents; D000069283:Rituximab