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A case of cervical spine meningioma following etanercept use in a patient with RA

Nature Reviews Rheumatology volume 5, pages 457–460 (2009)Cite this article

Abstract

Background. A 70-year-old female with active rheumatoid arthritis (RA) was administered etanercept to treat active disease that persisted despite therapy with conventional DMARDs. After 18 months of etanercept therapy, her RA symptoms had improved; however, she developed quadriparesis. She presented to a specialist rheumatology clinic with weakness and numbness in her arms and legs; she also had difficulty in standing up and walking.

Investigations. Physical examination, neurological examination, nerve conduction studies, measurement of serum inflammatory markers and autoantibodies, MRI of the cranium and cervical spine, and X-rays of the chest and hands.

Diagnosis. The patient underwent neurosurgery to resect a 1 × 2 cm mass in the cervical spine at C6–C7. Histopathologic examination of the excised mass revealed it to be a meningioma.

Management. Etanercept was discontinued because of a possible association between the drug and development of meningioma; however, shortly afterwards the patient experienced a flare of RA symptoms. High-dose NSAIDs and prednisolone were administered, but the patient died because of gastric perforation. To our knowledge, this is the first report in the literature of meningioma developing following use of tumor necrosis factor inhibitor therapy, and the first to suggest a cause–effect relationship.

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Acknowledgements

The authors are grateful to the patient's family for granting permission to write this case report.

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Authors and Affiliations

  1. Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey

    Ömer N. Pamuk

  2. Division of Gastroenterology, Zonguldak Karaelmas University Medical Faculty, Zonguldak, Turkey

    Ferda Harmandar

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  1. Ömer N. Pamuk
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  2. Ferda Harmandar
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Correspondence to Ömer N. Pamuk.

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Pamuk, Ö., Harmandar, F. A case of cervical spine meningioma following etanercept use in a patient with RA. Nat Rev Rheumatol 5, 457–460 (2009). https://doi.org/10.1038/nrrheum.2009.138

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