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Aseptic meningitis occurring during anti-TNF-alpha therapy in rheumatoid arthritis and ankylosing spondylitis

Ilaria Cavazzana1, Mara Taraborelli, Micaela Fredi

  • 1Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy. ilariacava@virgilio.it.

Clinical and Experimental Rheumatology
|September 9, 2014
PubMed
Abstract

Insights

Aseptic meningitis is a rare complication in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients on anti-tumor necrosis factor-alpha (TNF-α) therapy. Discontinuation of TNF-α and steroid treatment led to symptom resolution.

Area of Science:

  • Rheumatology
  • Neurology
  • Immunology

Background:

  • Aseptic meningitis is a rare but severe complication of rheumatoid arthritis (RA).
  • Tumor necrosis factor-alpha (TNF-α) inhibitors are commonly used to treat RA and ankylosing spondylitis (AS).
  • The occurrence of aseptic meningitis during anti-TNF-α therapy requires further investigation.

Observation:

  • Four patients (0.55%) developed meningitis after a mean of 5 years of anti-TNF-α therapy.
  • Neurological symptoms included focal epilepsy and dysarthria.
  • Cerebral imaging revealed leptomeningeal enhancement and, in one case, cerebritis.

Findings:

  • Cerebral biopsy confirmed lymphocytic aggregates, excluding infectious causes.
  • All patients discontinued anti-TNF-α therapy and received high-dose steroids, with two also receiving methotrexate.
  • Neurological symptoms resolved without residuals, and meningeal enhancement showed late resolution.

Implications:

  • Meningeal inflammation is a rare extra-articular manifestation in long-standing RA and AS, even during anti-TNF-α therapy.
  • Anti-TNF-α therapy does not prevent this complication.
  • Early diagnosis and management involving drug cessation and immunosuppression are crucial for favorable outcomes.

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