Pulmonary fibrosis in a patient with rheumatoid arthritis treated with adalimumab

The tumor necrosis factor (TNF ) inhibitors infliximab, etanercept, and adalimumab are nowadays widely used in the treatment of rheumatoid arthritis (RA). Side effects are mostly related to their strong immunosuppressive effects, resulting in infections such as tuberculosis. In recent years, a number of cases have been reported linking the use of the TNF inhibitors infliximab and etanercept to interstitial lung disease. A direct role could not be ascertained, however, because of the concomitant use of methotrexate, presence of mycobacterial infection, or preexistence of lung fibrosis.