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Fatal exacerbation of fibrosing alveolitis associated with systemic sclerosis in a patient treated with adalimumab
  1. Y Allanore1,
  2. G Devos-François2,
  3. C Caramella1,
  4. P Boumier3,
  5. V Jounieaux2,
  6. A Kahan1
  1. 1Paris-Descartes University, Rheumatology A Department, Cochin Hospital, AP-HP, Paris, France
  2. 2Pneumology Department, CHU, Amiens, France
  3. 3Rheumatology Department, CHU, Amiens, France
  1. Correspondence to:
    Dr Y Allanore
    Hôpital Cochin, Service de Rhumatologie A, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; yannick.allanore{at}cch.ap-hop-paris.fr

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Several cases of fatal exacerbations of fibrosing alveolitis associated with rheumatoid arthritis after infliximab treatment have recently been reported.1 We report here a case of fatal exacerbation of pulmonary fibrosis after adalimumab treatment in a patient with polyarthritis related to systemic sclerosis (SSc).

The patient, a 74 year old woman, had been diagnosed 5 years previously with severe Raynaud’s syndrome, sclerodactyly, pulmonary fibrosis, abnormal oesophageal peristalsis, and non-specific antinuclear antibodies (1/100; indirect immunofluorescence on Hep 2 cells). She also had severe distal polyarthritis affecting the wrists, metacarpophalangeal and proximal interphalangeal joints, with demineralisation but no erosion on x ray examination. She tested negative for rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Successive treatments with low dose prednisone associated with methotrexate, leflunomide or azathioprine were ineffective.

In February 2004 she had a 28 joint count Disease Activity Score (DAS28) score of 7.8, a …

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