Rheumatoid arthritis with necrotic lung nodules

Rheumatoid arthritis is a multisystemic inflammatory disease. Lungs are the commonest site of extra-articular involvement. Rheumatoid lung nodules occur infrequently and can undergo necrosis giving rise to necrobiotic lung nodules. Infections, malignancy and granulomatosis with polyangiitis are more common causes of cavitating lung nodules. Presence of rheumatoid factor, history of smoking and use of methotrexate increase the chances of developing rheumatoid lung nodulosis. Histopathological examination of the nodule is essential to make a correct diagnosis.

Progressive multifocal leukoencephalopathy associated with infliximab

A 69-year-old female with seropositive rheumatoid arthritis presented with progressive cognitive decline following treatment with infliximab and methotrexate. Cranial MRI showed non-enhancing white matter signal abnormality consistent with demyelination was seen in the antero-inferior left frontal lobe extending into the frontal opercular white matter and into the left temporal lobe white matter. Similar appearances were seen in the inferomedial right frontal lobe. Brain biopsy showed histological changes consistent with progressive multifocal leukoencephalopathy.

New biologics for rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory arthritis with many systemic manifestations. Several monoclonal antibodies targeting different components of the immune systems have been licensed for treatment of RA. Inflammatory cytokines such as interleukin-6 (IL-6) are found abundantly in the blood and the joints. The biologic effect of IL-6 on leukocyte, osteoclast, hepatocytes and bone marrow may mediate the articular and systemic inflammation in RA.

New biologics for rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory arthritis with many systemic manifestations. Several monoclonal antibodies targeting different components of the immune systems have been licensed for treatment of RA. Inflammatory cytokines such as interleukin-6 (IL-6) are found abundantly in the blood and the joints. The biologic effect of IL-6 on leukocyte, osteoclast, hepatocytes and bone marrow may mediate the articular and systemic inflammation in RA.