Abstract
Tumor necrosis factor (TNF) antagonists have brought about a significant advancement in treatment for autoimmune diseases such as rheumatoid arthritis (RA) and Crohn’s disease; however, they are accompanied with a risk of severe adverse effects. We report the case of a 68-year-old female with a 33-year history of RA that developed multiple sclerosis (MS) during adalimumab (ADM) treatment at 22 months after the initial administration. Her first neurological symptom was mild dizziness, which progressed to severe dizziness with gait disturbance within 2 weeks. Fortunately, when she had this neurological disorder, ADM treatment was being transiently stopped because she was in the perioperative period. Repeated magnetic resonance imaging examinations revealed multiple demyelinating lesions in her brain, leading to the diagnosis of MS. The patient completely recovered spontaneously from the symptoms in several days. A review of the literature revealed another 15 cases of MS associated with anti-TNF-α treatment, emphasizing the importance of detecting neurological symptoms and discontinuing the anti-TNF-α therapy.
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References
Scheinfeld N (2004) A comprehensive review and evaluation of the side effects of the tumor necrosis factor alpha blockers etanercept, infliximab and adalimumab. J Dermatolog Treat 15:280–294
Lozeron P, Denier C, Lacroix C, Adams D (2009) Long-term course of demyelinating neuropathies occurring during tumor necrosis factor-alpha-blocker therapy. Arch Neurol 66:490–497
Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
Mohan N, Edwards ET, Cupps TR, Oliverio PJ, Sandberg G, Crayton H, Richert JR, Siegel JN (2001) Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides. Arthritis Rheum 44:2862–2869
Schiff MH, Burmester GR, Kent JD, Pangan AL, Kupper H, Fitzpatrick SB, Donovan C (2006) Safety analyses of adalimumab (HUMIRA) in global clinical trials and US postmarketing surveillance of patients with rheumatoid arthritis. Ann Rheum Dis 65:889–894
Sharief MK, Hentges R (1991) Association between tumor necrosis factor-alpha and disease progression in patients with multiple sclerosis. N Engl J Med 325:467–472
Selmaj K, Raine CS, Farooq M, Norton WT, Brosnan CF (1991) Cytokine cytotoxicity against oligodendrocytes. Apoptosis induced by lymphotoxin. J Immunol 147:1522–1529
Selmaj KW, Raine CS (1995) Experimental autoimmune encephalomyelitis: immunotherapy with anti-tumor necrosis factor antibodies and soluble tumor necrosis factor receptors. Neurology 45:S44–S49
van Oosten BW, Barkhof F, Truyen L, Boringa JB, Bertelsmann FW, von Blomberg BM, Woody JN, Hartung HP, Polman CH (1996) Increased MRI activity and immune activation in two multiple sclerosis patients treated with the monoclonal anti-tumor necrosis factor antibody cA2. Neurology 47:1531–1534
Group TLMSSGaTUoBCMMA (1999) TNF neutralization in MS: results of a randomized, placebo-controlled multicenter study. The Lenercept Multiple Sclerosis Study Group and The University of British Columbia MS/MRI Analysis Group. Neurology 53:457–465
Toussirot E, Pertuiset E, Martin A, Melac-Ducamp S, Alcalay M, Grardel B, Seror P, Perdriger A, Wendling D, Mulleman D, Beraneck L, Mariette X (2006) Association of rheumatoid arthritis with multiple sclerosis: report of 14 cases and discussion of its significance. J Rheumatol 33:1027–1028
Tanno M, Nakamura I, Kobayashi S, Kurihara K, Ito K (2006) New-onset demyelination induced by infliximab therapy in two rheumatoid arthritis patients. Clin Rheumatol 25:929–933
Sicotte NL, Voskuhl RR (2001) Onset of multiple sclerosis associated with anti-TNF therapy. Neurology 57:1885–1888
Titelbaum DS, Degenhardt A, Kinkel RP (2005) Anti-tumor necrosis factor alpha-associated multiple sclerosis. AJNR Am J Neuroradiol 26:1548–1550
Al Saieg N, Luzar MJ (2006) Etanercept induced multiple sclerosis and transverse myelitis. J Rheumatol 33:1202–1204
Bensouda-Grimaldi L, Mulleman D, Valat JP, Autret-Leca E (2007) Adalimumab-associated multiple sclerosis. J Rheumatol 34:239–240, discussion 240
Gomez-Gallego M, Meca-Lallana J, Fernandez-Barreiro A (2008) Multiple sclerosis onset during etanercept treatment. Eur Neurol 59:91–93
Davis SA, Johnson RR, Pendleton JW (2008) Demyelinating disease associated with use of etanercept in patients with seronegative spondyloarthropathies. J Rheumatol 35:1469–1470
Pfueller CF, Seipelt E, Zipp F, Paul F (2008) Multiple sclerosis following etanercept treatment for ankylosing spondylitis. Scand J Rheumatol 37:397–399
Fromont A, De Seze J, Fleury MC, Maillefert JF, Moreau T (2009) Inflammatory demyelinating events following treatment with anti-tumor necrosis factor. Cytokine 45:55–57
Cruz Fernandez-Espartero M, Perez-Zafrilla B, Naranjo A, Esteban C, Ortiz AM, Gomez-Reino JJ, Carmona L (2011) Demyelinating disease in patients treated with TNF antagonists in rheumatology: data from BIOBADASER, a pharmacovigilance database, and a systematic review. Semin Arthritis Rheum 41:524–533
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Matsumoto, T., Nakamura, I., Miura, A. et al. New-onset multiple sclerosis associated with adalimumab treatment in rheumatoid arthritis: a case report and literature review. Clin Rheumatol 32, 271–275 (2013). https://doi.org/10.1007/s10067-012-2113-2
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DOI: https://doi.org/10.1007/s10067-012-2113-2