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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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References

  1. Smitten, A. L., Simon, T. A., Hochberg, M. C. & Suissa, S. A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Res. Ther. 10, R45 (2008).

    Article  Google Scholar 

  2. Zintzaras, E., Voulgarelis, M. & Moutsopoulos, H. M. The risk of lymphoma development in autoimmune diseases: a meta-analysis. Arch. Intern. Med. 165, 2337–2344 (2005).

    Article  Google Scholar 

  3. Kaiser, R. Incidence of lymphoma in patients with rheumatoid arthritis: a systematic review of the literature. Clin. Lymphoma Myeloma 8, 87–93 (2008).

    Article  Google Scholar 

  4. Askling, J. et al. Anti-tumor necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register. Ann. Rheum. Dis. 68, 648–653 (2008).

    Article  Google Scholar 

  5. Geborek, P. et al. Tumour necrosis factor blockers do not increase overall tumour risk in patients with rheumatoid arthritis, but may be associated with an increased risk of lymphomas. Ann. Rheum. Dis. 64, 699–703 (2005).

    Article  CAS  Google Scholar 

  6. Cibere, J., Sibley, J. & Haga, M. Rheumatoid arthritis and the risk of malignancy. Arthritis Rheum. 40, 1580–1586 (1997).

    Article  CAS  Google Scholar 

  7. Wolfe, F. & Michaud, K. Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18, 572 patients. Arthritis Rheum. 50, 1740–1751 (2004).

    Article  CAS  Google Scholar 

  8. Wolfe, F. & Michaud, K. Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study. Arthritis Rheum. 56, 2886–2895 (2007).

    Article  Google Scholar 

  9. Wolfe, F. & Michaud, K. The effect of methotrexate and anti-tumor necrosis factor therapy on the risk of lymphoma in rheumatoid arthritis in 19,562 patients during 89,710 person-years of observation. Arthritis Rheum. 56, 1433–1439 (2007).

    Article  CAS  Google Scholar 

  10. Askling, J. et al. Haematopoietic malignancies in rheumatoid arthritis: lymphoma risk and characteristics after exposure to tumor necrosis factor antagonists. Ann. Rheum. Dis. 64, 1414–1420 (2005).

    Article  CAS  Google Scholar 

  11. Askling, J. et al. Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumor necrosis factor anatagonists. Ann. Rheum. Dis. 64, 1421–1426 (2005).

    Article  CAS  Google Scholar 

  12. Bongartz, T. et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295, 2275–2285 (2006).

    Article  CAS  Google Scholar 

  13. Setoguchi, S. et al. Tumor necrosis alpha antagonist use and cancer in patients with rheumatoid arthritis. Arthritis Rheum. 54, 2757–2764 (2006).

    Article  CAS  Google Scholar 

  14. Mirimanoff, R. O., Dosoretz, D. E., Linggood, R. M., Ojemann, R. G. & Martuza, R. L. Meningioma: analysis of recurrence and progression following neurosurgical resection. J. Neurosurg. 62, 18–24 (1985).

    Article  CAS  Google Scholar 

  15. Solero, C. L. et al. Spinal meningiomas: review of 174 operated cases. Neurosurgery 25, 153–160 (1989).

    Article  CAS  Google Scholar 

  16. Levy, W. J. Jr, Bay, J. & Dohn, D. Spinal cord meningioma. J. Neurosurg. 57, 804–812 (1982).

    Article  Google Scholar 

  17. Marosi, C. et al. Meningioma. Crit. Rev. Oncol. Hematol. 67, 153–171 (2008).

    Article  Google Scholar 

  18. Stübgen, J. P. Tumor necrosis factor-alpha antagonists and neuropathy. Muscle Nerve 37, 282–292 (2008).

    Article  Google Scholar 

  19. Tsegaye, M., Bassi, S. & Ashpole, R. D. Extradural spinal cord compression by rheumatoid nodule. Br. J. Neurosurg. 17, 255–257 (2003).

    Article  CAS  Google Scholar 

  20. Schneider, B., Pülhorn, H., Röhrig, B. & Rainov, N. G. Predisposing conditions and risk factors for development of symptomatic meningioma in adults. Cancer Detect. Prev. 29, 440–447 (2005).

    Article  Google Scholar 

Download references

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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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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