Aseptic meningitis in rheumatoid arthritis after anti-TNF administration: a case-based literature review

Area of Science:

• Neurology
• Rheumatology
• Immunology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease with articular and extra-articular manifestations.
• Rheumatoid meningitis (RM) is a rare extra-articular complication presenting with diverse neurological symptoms.
• RA treatments, including biologics, can induce meningitis or increase infection risk.

Observation:

• A patient with longstanding RA developed left-sided weakness and seizure after initiating etanercept (ETA) therapy.
• Diagnostic evaluation confirmed ETA-induced meningitis.
• This presentation underscores the diagnostic complexities in RA patients with neurological deficits.

Findings:

• Etanercept (ETA) can induce aseptic meningitis in rheumatoid arthritis (RA) patients.
• Early diagnosis of RM is critical for favorable prognosis.
• Differential diagnosis of neurological symptoms in RA requires careful consideration of drug-induced and infectious causes.

Implications:

• Clinicians should consider drug-induced meningitis in RA patients presenting with neurological symptoms, especially after initiating new therapies like etanercept.
• Prompt diagnosis and management of RM are essential to improve patient outcomes.
• This case highlights the importance of recognizing rare neurological complications in autoimmune diseases.