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 …