Rheumatoid meningitis is a rare but lethal disorder that occurs in an elderly population with longstanding rheumatoid arthritis (RA).¹ Although the majority of patients experience neurological symptoms, up to 26% of the patients were asymptomatic in a case series study as identified by necropsy.¹ There is poor correlation between the severity of synovitis and neurological symptoms, which therefore imposes a challenge in the diagnosis of this condition.¹ To date there are no established treatment regimens for rheumatoid meningitis, although most patients receive immunosuppressive agents. Although the anti-tumour necrosis factor (TNF) agents have been proved to provide significant relief for the articular manifestations of RA, their effectiveness for rheumatoid meningitis has not been reported.²

A 58 year old woman with previous diagnoses of fibromyalgia and osteoarthritis was referred to the rheumatology clinic of the Massachusetts General Hospital (MGH) with worsening polyarthritis of both hands, wrists, knees, and ankles while receiving daily rofecoxib, 25 mg. Before the visit she had undergone extensive investigation for a 6 …