Inflammatory demyelinating events following treatment with anti-tumor necrosis factor.
BACKGROUND
Tumor necrosis factor alpha (TNF-alpha) is an inflammatory cytokine involved in certain inflammatory diseases including multiple sclerosis (MS), rheumatoid arthritis (RA), and Crohn's disease. The anti-TNF-alpha treatments used for RA may be associated with inflammatory demyelinating events affecting the central nervous system and may possibly aggravate known MS.


OBJECTIVE
We report here three new cases of inflammatory demyelinating events of the central nervous system following treatment with anti-TNF-alpha.


RESULTS
The neurological symptoms appeared on average 5 months after initiation of the treatment. For all patients, the inflammatory process was confirmed by brain magnetic resonance imaging. The symptoms totally or partially regressed as soon as anti-TNF-alpha treatment was stopped except for one patient who developed clinically defined MS.


CONCLUSIONS
Inflammatory demyelination of the central nervous system may be associated with the use of anti-TNF-alpha. Patients with rheumatoid arthritis treated with these treatments should benefit from a follow-up which includes brain MRI.
Fromont
A
A
Department of Neurology, University Hospital of Dijon, 21000 Dijon, France.
De Seze
J
J
Fleury
M C
MC
Maillefert
J F
JF
Moreau
T
T
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D001921:Brain / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology; D003711:Demyelinating Diseases / Q000139:chemically induced / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D007249:Inflammation / Q000139:chemically induced / Q000276:immunology; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; D014409:Tumor Necrosis Factor-alpha