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Nephritis, cerebritis, and myositis after adalimumab therapy in a patient with rheumatoid arthritis: a case report

Authors Omran NE, Noorwali AA

Received 22 October 2017

Accepted for publication 20 February 2018

Published 11 April 2018 Volume 2018:11 Pages 151—154


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Scott Fraser

Narges E Omran,1 Abdulsalam A Noorwali2

1Department of Internal Medicine and Rheumatology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia; 2Department of Internal Medicine and Rheumatology, Umm Al Qura University Hospital, Makkah, Saudi Arabia

Abstract: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that mainly affects the joints, therefore, may cause deformities and disability if untreated. The first line of treatment is disease-modifying antirheumatic drugs (DMARDs). When the patient fails to respond to DMARDs, mainly methotrexate, then second-line therapy is required. Tumor necrosis factor α (TNFα) plays an important role in the pathogenesis of RA; however, the treatment with anti-TNFα medications is challenging. It may trigger the autoimmune system and result in producing antibodies that induce symptoms and signs mimic to systemic lupus erythematosus (SLE), and in rare situations can affect vital organs with severe and life-threatening complications. We report on a 38-year-old Saudi woman with longstanding erosive RA, who was diagnosed based on the 1987 classification criteria. She developed life-threatening SLE, and seroconversion of antinuclear antibodies (ANA), anti-double-stranded DNA, with severe systemic involvement (cerebritis, nephritis, myositis, and polyneuropathy), shortly after treatment with adalimumab. Adalimumab was started as anti TNFa therapy (after the failure of traditional therapy), SLE and other autoimmune diseases were ruled out by clinical history, examination, and laboratory investigations, including negative ANAs and anti-double-stranded DNA. When both tests turned out persistently positive even after stopping adalimumab, specific diagnostic and therapeutic modalities were required during her acute illness.

Keywords: rheumatoid, arthritis, tumor necrosis factor, adalimumab, anti-TNF, systemic lupus erythematosus

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