Related Experiment Video

Updated: May 28, 2026

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
04:50

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain

Published on: May 16, 2025

Rheumatoid meningitis occurring during adalimumab and methotrexate treatment

Anne-Catherine M L Huys1, Pierre-André Guerne, Judit Horvath

  • 1Department of Neurology, University Hospitals of Geneva, rue Gabrielle Perret Gentil, 4, CH-1211 Geneva 14, Switzerland. a.m.l.huys.01@cantab.net

Joint Bone Spine
|October 4, 2011
PubMed

Insights

Rheumatoid meningitis, a rare complication, can occur during treatment for rheumatoid arthritis with methotrexate and TNF blockers like adalimumab. Early diagnosis and drug withdrawal are crucial for patient recovery.

Area of Science:

  • Neurology
  • Rheumatology
  • Immunology

Background:

  • Rheumatoid arthritis (RA) frequently presents with extra-articular manifestations.
  • Treatment for RA often involves disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and biologic agents like TNF inhibitors.

Observation:

  • A case of chronic rheumatoid meningitis developed in a 59-year-old female patient undergoing treatment with methotrexate and adalimumab.
  • The patient presented with headaches, psychomotor retardation, and seizures after 9 and 7 months of treatment, respectively.

Findings:

  • Brain biopsy confirmed necrotizing granulomatous meningitis, a rare neurological complication.
  • Withdrawal of methotrexate and adalimumab, coupled with high-dose corticosteroids, resulted in significant clinical improvement.
  • Subsequent treatment with rituximab enabled corticosteroid discontinuation.

Implications:

  • This case highlights that TNF inhibitors and methotrexate may not prevent, and could potentially contribute to, the development of rheumatoid meningitis.
  • Prompt recognition and management, including drug cessation and immunosuppression, are vital for favorable outcomes in this rare condition.

Related Concept Videos

Bacterial Meningitis01:24

Bacterial Meningitis

Bacterial meningitis is a severe infectious disease involving inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. It occurs when pathogenic bacteria cross the blood–brain barrier and enter the cerebrospinal fluid. Common causative organisms include Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Listeria monocytogenes, and Escherichia coli K1. The exact route of entry varies by pathogen and host condition.Routes of Entry...
Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
Rocky Mountain Spotted Fever01:26

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever (RMSF) is a severe tick-borne illness caused by Rickettsia rickettsii, a Gram-negative, coccobacillary bacterium. This pathogen is an obligate intracellular parasite, requiring a host cell for replication. Transmission occurs through the bite of an infected tick. In the United States, the most important vectors are Dermacentor variabilis (American dog tick) and Dermacentor andersoni (Rocky Mountain wood tick), though other tick species may also serve as vectors.
Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...