Coexistence of multiple sclerosis and ankylosing spondylitis: report of two cases.
BACKGROUND
Multiple sclerosis (MS) only rarely coexists with ankylosing spondylitis (AS). The optimal management of these patients represents a major challenge.


METHODS
In the present study, we report 2 cases of AS with definite MS comorbidity. One of the AS-MS cases had received anti-TNFα treatment, which was discontinued due to exacerbation of the MS. In addition, we discuss 3 more AS cases with neurological symptoms and atypical white matter demyelinating MRI lesions after anti-TNFα treatment.


CONCLUSIONS
Given the fact that anti-TNFα drugs can potentially exacerbate a latent MS or induce atypical demyelination in the central nervous system, they should be discouraged or discontinued in relevant cases. The remaining effective therapeutic options for MS are either contradictory for AS (interferon-β), have no definite data regarding their safety/efficacy in AS (glatiramer acetate, azathioprine, natalizumab, fingolimod), or their efficacy in MS-AS is associated with increased treatment risks (rituximab). Any of these proposed treatments may require active patient's informed consent.
B' Department of Neurology, AHEPA University Hospital and Aristotle University School of Medicine, Thessaloniki, Macedonia, Greece.
A
A
Lourbopoulos
P
P
Ioannidis
E
E
Boura
D
D
Antoniadis
D
D
Karacostas
N
N
Grigoriadis
D000328:Adult; D001921:Brain / Q000473:pathology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000473:pathology