Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory disease that can lead to systemic involvement especially related to significant joint pain and disability. Tumour necrosis factor (TNF) has a pivotal role in its pathogenesis. TNF also has effects on the formation of granuloma and the defensive mechanisms against the intracellular injuries. While a case with RA has been evaluated before the TNF alpha antagonist treatment, the presence of respiratory symptoms and bilateral cavitary lung lesions led to further investigations and was diagnosed as accompanying Wegener granulomatosis. The effect of that coincidence on treatment decision was aimed at discussing a case report as being a rare condition
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