1. Case 1 Chart number:20139683 name: 林 XX Occupation: 水電工 Age:55 years old Sex: male

2. Major event 2008/9/2 Diagnosed RA 2009/5/26 Start Humira 2010/5/4 OPD :QFT (+) 2010/5/10 Open TB 2010/6/01 Stop Humira 2010/10/19 Shift Rituximab

3. 2008/9/2: diagnosed RA with DAS-28:8.3 Start MTX 10mg QW,HCQ 200mg QD( from 9/2),Leflunomide 20mg QD and prednisolone 5mg QD (from 11/11) back

4. DAS 28 Humira DC Humira due to TB Rituximab

5. 2009/5/26 PPD negative Quantiferon test negative CXR no active lesion Start Adalimumab due to high RA disease activity under DMARDs(DAS 28:5.53) back

6. DAS 28 Humira DC Humira due to TB Rituximab

7. Return rheuma OPD on 5/4 QFT follow-up (+) Lack of AFB result due to no productive cough CXR suspected pulmonary TB Start INH 300mg QD

8. 2010/5/10: admitted to chest ward due to prolonged fever one week and productive cough Sputum AFB positive Diagnosed : pulmonary miliary TB Stop Humira Treated with Rifater + EMB back

9. DAS 28 Humira DC Humira due to TB Rituximab back

10. DAS 28 Humira DC Humira due to TB Rituximab

11. Return chest OPD 2010/7/27 Sputum culture :M. tuberculosis complex sensitive to all anti-TB medications Discontinue EMB since 2010/9/21 Complete 9 months TB treatment on 2011/2/15

12. Case 2 Chart number:2453132 name: 陳 XX Occupation: housekeeper Age:52 Sex: female

13. Major event 2000 diagnosed RA 2000-2006 treat with DMARs 2006/10 Add Leflunomide 2006/12 Abnormal LFT 2007/3 DC MTX and Leflunomide Start LMV 2007/12 Change ETV 2008/8 Stop ETV 2008 /3 Enbrel 2009/10 Abnormal LFT Stop Enbrel Start ETV 2010/9 Resume Enbrel

14. Present illness Past history with hepatitis B carrier Diagnosed with rheumatoid arthritis from 2000 2000-2004 – Treated with NSAID,HCQ and prednisolone 5mg QD – Added MTX (15mg QW) from 2004/11/3 – Add Leflunomide 10mg QD from 2006/10/7 back

15. ALT and total bilirubin 2007/2 HBV-DNA 5.61 Mcps 2007/8 HBV-DNA <0.00035Mcps 2008/7 HBV-DNA Non-detectable 2009/3 HBV-DNA 0.119Mcps Enbrel DC Enbrel Add ETV Complete ETV

16. DAS 28 Enbrel DC Enbrel Resume Enbrel

17. Case 3 Chart number:20020457 name: 林 XX Occupation: 機車修理退休 Age:69 Sex: male

18. Major event 2000/7/17 Diagnosed RA 2004/8/29 Start Enbrel 2006/9/19 Stop Enbrel 2011/1/13 lymphoma

19. 2000/7/17 : diagnosed with Rheumatoid arthritis Start MTX 7.5 mg QW and Sulfasalazine 500mg BID back

20. DAS 28 DC Enbrel back

21. 2006/9/9 admission Stop Enbrel and MTX on due to pancytopenia 2006/9/7 Abdominal echo – Fatty liver and splenomegaly – Consider Felty’s syndrome 2006 9/59/7 9/1911/28 WBC1700310094006400 Hb9.19.211.512.9 PLT82K113K156K142K

22. DAS 28 DC Enbrel back

23. 2011/1/13 : Prolonged fever for one month Right neck lymph node biopsy – Nodular sclerosis classical Hodgkin lymphoma DAS28:2.79 Treat lymphoma with 8 cycles ABVD on 2011/3/10 - 2011/10/20 (Doxorubicine,Bleomycin, Vinblastin, and Dacarbazine)