title: A case of leukoencephalopathy associated with adalimumab-treated rheumatoid arthritis and a review of literature.
abstract: Tumor necrosis factor-alpha (TNF-alpha) inhibitor is recently being widely used to treat autoimmune diseases, but some noticeable adverse events were reported and neurological events have especially been described. It is mandatory to compare these cases for finding the risk factors, the duration of the neurological events, their processes and their outcomes. We present here the case of leukoencephalopathy secondary to adalimumab, which is a tumor necrosis factor α (TNF-α) inhibitor. We also reviewed the other 14 published leukoencephalopathy cases associated with the use of TNF inhibitors. Eleven patients had underlying rheumatoid arthritis, and the others had psoriatic arthritis, ankylosing spondylitis and Still's disease. The median duration of treatment with anti-TNF-α before the presentation of neurological symptoms was 9.2 months (range: 1.5-24). The duration of using anti-TNF-α was not related with the outcome. Although cases of neurological adverse events associated with anti-TNF-α treatment are rare, it is very important to monitor the neurological signs and symptoms suggestive of a demyelinating disorder in RA patients who are receiving anti-TNF-α treatment and especially those patients who are older and who have a history of MS or demyelination.
authors: Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Yang-Seon
authors: YS
authors: Ryu
authors: Sung-Hwan
authors: SH
authors: Park
authors: Ji-Min
authors: JM
authors: Kim
authors: Eun-Ji
authors: EJ
authors: Kim
authors: Jennifer
authors: J
authors: Lee
authors: Seung-Ki
authors: SK
authors: Kwok
authors: Ji-Hyeon
authors: JH
authors: Ju
authors: Ho-Youn
authors: HY
authors: Kim
mesh_terms: D000068879:Adalimumab; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D056784:Leukoencephalopathies / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab