Rheumatoid Meningoencephalitis: A Feared Condition in the Era of TNF Blockers

Table 1

Overview of patients with rheumatoid meningitis and meningoencephalitis.

	No exposure to TNF blockers	Exposure to TNF blockers
Number of cases reported	28	12
Age, median	66	59
Male (%)	11 (39%)	3 (27%)
Length of illness, median	4.5 years	10 years
Number of patients whose length of illness is greater than 10 years	11 (39%)	6 (55%)
Number of patients with active rheumatoid arthritis, (%)	9 (32%)	6 (55%)
RA treatment
Methotrexate	14 (68%)	9 (82%)
Corticosteroid	11 (39%)	3 (27%)
TNF blocker used, (%)	N/A	Infliximab 6 (50%)
		Adalimumab 4 (33%)
		Etanercept 1 (8.5%)
		Golimumab 1 (8.5%)
Positive brain MRI	100%	8 (73%)
Meningitis treatment
Corticosteroid	23 (82%)	8 (73%)
Cyclophosphamide	7 (25%)	2 (18%)
Other treatments	Azathioprine 1	Azathioprine 1
	MTX 4	Rituximab 1
	TNF blockers 0	Infliximab 1
CSF RF positivity	2	0
CSF WBC, median	36	69
CSF protein, median	67	67
CSF glucose, median	58	48
Positive biopsy or autopsy pathology	19 (68%)	6 (55%)
Good prognosis	19 (68%)	7 (64%)

No author reported CSF RF results in the TNF blocker exposure group.