New-onset multiple sclerosis associated with adalimumab treatment in rheumatoid arthritis: a case report and literature
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CASE BASED REVIEW
New-onset multiple sclerosis associated with adalimumab treatment in rheumatoid arthritis: a case report and literature review Takumi Matsumoto & Ichiro Nakamura & Ayumi Miura & Gen Momoyama & Katsumi Ito
Received: 7 September 2012 / Revised: 22 October 2012 / Accepted: 26 October 2012 / Published online: 14 November 2012 # Clinical Rheumatology 2012
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. Keywords Adalimumab . Demyelination . Magnetic resonance imaging (MRI) . Multiple sclerosis . Rheumatoid arthritis . Tumor necrosis factor T. Matsumoto : I. Nakamura (*) : A. Miura : G. Momoyama : K. Ito Department of Rheumatology, Yugawara Kosei-Nenkin Hospital, 438 Miyakami, Yugawara, Ashigara-shimo, Kanagawa 259-0396, Japan e-mail: [email protected] I. Nakamura Department of Orthopedic Surgery, Mitsui Memorial Hospital, 1 Izumicho, Kanda, Chiyoda, Tokyo 101-8643, Japan
Introduction Tumor necrosis factor (TNF) antagonists provide a considerable benefit to patients with inflammatory autoimmune diseases such as rheumatoid arthritis (RA), ankylosing spondylitis, and Crohn’s disease. On the other hand, they are associated with various side effects including serious infections, systemic lupus erythematosus, malignant lymphoma, congestive heart failure, and demyelinating disorders [1]. The demyelinating disorders associated with TNF-α antagonists include multiple sclerosis (MS), optic neuritis, transverse myelitis, and Guillain-Barre syndrome [2]. Particularly, MS has been considered as one of the most serious presentations. Therefore, adequate attention should be paid to neurological abnormalities in patients treated with anti-TNF-α agents. Here, we report an RA patient who developed MS during adalimumab (ADM) therapy. Incidentally, when the neurological symptoms occurred, ADM treatment was being stopped in preparation for her eye operation. The symptoms were completely resolved over several days without providing any aggressive treatment s
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