title: Drug free remission after steroid-dependent disappearance of lymphoproliferative disorder in rheumatoid arthritis patient treated with TNF-alpha blockade: case study.
abstract: BACKGROUND
  TNF-α inhibitors plus MTX appear to have benefit in the longer-term reduction of RA. Boolean long-term remission under drug-free conditions is rare. The therapeutic mechanism and the factor of predicting response have not been clarified yet.
  
  
  METHODS
  A 24-year-old female rheumatoid arthritis (RA) patient, who once attained complete remission (CR) with the combination therapy with tumor necrosis factor alpha (TNF-alpha) inhibitor adalimumab (ADA) and methotrexate (MTX), showed the occurrence of Epstain- Barr virus (EBV)-associated lymphoproliferative disorder (LPD). Pulse treatment with methylprednisolone after the termination of anti TNF-α therapy resulted in the remission of EBV-associated LPD. The administration of prednisolone (PSL) was tapered off after the improvement of clinical symptoms and laboratory data. The patients achieved drug-free 12 months after urgent hospitalization and delivered healthy baby 2 years after hospital discharge. She has been complete drug-free Boolean remission for 5 years.
  
  
  RESULTS
  The purpose of this brief case is report that we experienced the remission of LPD after CR with combined therapy with ADA and MTX. We believe this case report will be one of the paths for unveiling the pathogenesis and improving the treatment for RA.
  
  
  CONCLUSIONS
  We believe this case report will be one of the paths for unveiling the pathogenesis and improving the treatment for RA.
authors.affiliation: Department of Orthopedic Surgery, Takatsuki Red Cross Hospital, 1-1-1 Abuno, Takatsuki, Osaka 569-1045 Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Oda
authors.affiliation: Department of Neurological Surgery, Ohio State University, 400 W Wiseman Hall 12th Ave, Columbus, Ohio 43210 USA.
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Minata
keywords: Complete remission; Lymphoproliferative disorder; Rheumatoid arthritis; Tumor necrosis factor alpha inhibitor