TNF and Parkinsonism: In 1 RA patient, features inconsistent with idiopathic Parkinson's disease included early-onset of upper-motor neuron findings.103 Interestingly, the other RA patient developed rapidly progressive Parkinsonism over a 12-month course of TNF-inhibitor therapy (infliximab), culminating with inability to ambulate, severe bulbar dysfunction, and dyspnea.121 Given that infliximab otherwise induced remission of her RA, it was suggested that the rapidity of Parkinsonism might be mediated by infliximab.