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Demyelinating disease (multiple sclerosis) in a patient with psoriatic arthritis treated with adalimumab: a case-based review

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Abstract

Over the past two decades, tumor necrosis factor-α (TNF-α) inhibitors became one of the most important drugs in the treatment of patients with psoriatic arthritis. Unfortunately, some of the patients exhibit unwanted side effects of the treatment. We describe a patient with psoriasis, psoriatic arthritis and uveitis who was treated with adalimumab and after 4 months of the treatment developed clinical and neuroradiological signs of demyelinating disease of the central nervous system. She experienced no signs and symptoms of neurological disease prior to adalimumab administration. After a detailed neurological work-up she was diagnosed with relapsing–remitting type of multiple sclerosis and treated with oral and pulse glucocorticoids and later with dimethyl fumarate. Adalimumab was discontinued. The question remains was the demyelination induced by the TNF-α blockade or was it unmasked by the introduction of the cytokine blocking agent. In patients suffering from inflammatory arthritis, treating disease to target as well as a close follow-up and knowledge of potential side effects of treatment remains crucial in good clinical practice.

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Funding

This research received no specific Grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia

    Marko Barešić & Branimir Anić

  2. Division of Physical Medicine, Rehabilitation and Rheumatology, National Memorial Hospital Vukovar, Vukovar, Croatia

    Mirna Reihl Crnogaj

  3. Department of Neurology, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia

    Ivana Zadro

Authors
  1. Marko Barešić
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  2. Mirna Reihl Crnogaj
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  4. Branimir Anić
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Contributions

Concept MRC, MB, IZ; design MB, MRC; supervision BA; data collection and/or processing MB, IZ; analysis and/or interpretation BA, MB; literature search MRC, MB; writing manuscript MRC, MB; critical review BA. 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 Marko Barešić.

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Barešić, M., Reihl Crnogaj, M., Zadro, I. et al. Demyelinating disease (multiple sclerosis) in a patient with psoriatic arthritis treated with adalimumab: a case-based review. Rheumatol Int 41, 2233–2239 (2021). https://doi.org/10.1007/s00296-021-04995-0

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  • DOI: https://doi.org/10.1007/s00296-021-04995-0

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