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Adalimumab-induced myasthenia gravis: case-based review

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Abstract

Myasthenia gravis (MG) is an autoimmune disease characterised by the presence of acetylcholine receptor antibodies and by blocking the transmission of the signal in the neuromuscular junction causing muscle weakness. It can be associated with several autoimmune diseases and certain drugs, between them Etanercept an anti-tumour necrosis factor (TNF) agent. A 42-year-old woman with rheumatoid arthritis (RA) refractory to methotrexate, was treated with adalimumab (ADA), a human monoclonal antibody against the TNF, in a dosage scheme of 40 mg every 14 days subcutaneously. The patient responded well to ADA therapy with sustained remission for 18 months when she developed blurred vision and eyelid ptosis of the left eye. The diagnosis of ocular MG was made. ADA has been discontinued and she started a treatment with pyridostigmine showing an excellent response and complete remission within a 2-month period. This is the first report making an association of ADA and ocular MG. Thus, rheumatologists dealing with patients treated with TNF inhibitors should be aware of the possible development of neurological adverse events, among them MG.

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Funding

This study was not funded by any means.

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Authors and Affiliations

  1. Department of Internal Medicine, Medical School, Rheumatology Clinic, University of Ioannina, 45110, Ioannina, Greece

    Eleftherios Pelechas, Tereza Memi, Theodora E. Markatseli, Paraskevi V. Voulgari & Alexandros A. Drosos

Authors
  1. Eleftherios Pelechas
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  2. Tereza Memi
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  3. Theodora E. Markatseli
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  4. Paraskevi V. Voulgari
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  5. Alexandros A. Drosos
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Contributions

All authors contributed equally to this manuscript. EP (also drafting of the manuscript), TM, and TEM searched the literature and PVV, and AAD reviewed critically and corrected the manuscript. Contributors’ statement all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Alexandros A. Drosos.

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The authors (Pelechas, Memi, Markatseli, Voulgari, Drosos) have no conflict of interest.

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This case is complying with the ethical standards of the University Hospital of Ioannina as it has been obtained an informed consent from the presented patient (informed consent has been uploaded as a different file—supplementary material).

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Pelechas, E., Memi, T., Markatseli, T.E. et al. Adalimumab-induced myasthenia gravis: case-based review. Rheumatol Int 40, 1891–1894 (2020). https://doi.org/10.1007/s00296-020-04587-4

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  • DOI: https://doi.org/10.1007/s00296-020-04587-4

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