Induction of complete and sustained remission of rheumatoid pachymeningitis by rituximab

• Published in: Arthritis and rheumatism Vol. 60; no. 6; pp. 1632 - 1634
• Main Authors: Schmid, L., Müller, M., Treumann, T., Arnold, W., Möller, B., Aeberli, D., Villiger, P. M.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-06-2009; Wiley
• Subjects: Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antigens, CD20 - metabolism; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; B-Lymphocytes - immunology; Biological and medical sciences; Diseases of the osteoarticular system; Humans; Immunomodulators; Inflammatory joint diseases; Magnetic Resonance Imaging; Male; Medical sciences; Meningitis - diagnosis; Meningitis - drug therapy; Meningitis - etiology; Middle Aged; Pharmacology. Drug treatments; Remission Induction; Rituximab; Treatment Outcome; Antineoplastic agent; Immunopathology; Diseases of the osteoarticular system; Rheumatology; Rituximab; Autoimmune disease; Inflammatory joint disease; Immunomodulator; Chronic; Pachymeningitis; Rheumatoid arthritis; Remission; Immunosuppressive agent
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/art.24577

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.