title: Multiple sclerosis following anti-tumor necrosis factor-alpha therapy for psoriasis: first case in Italy?
abstract: The use of tumor necrosis factor alpha (TNF-α) antagonists has greatly improved clinical management of psoriasis and other inflammatory diseases, but acute and chronic adverse reactions, including demyelination, are becoming increasingly recognized. We reported a case of multiple sclerosis in a 48-year-old Italian man with plaque psoriasis treated with etanercept. Through a literature review, we found a total of 35 psoriatic patients, including our case, in whom a demyelinating disease developed in course of TNF-α antagonists therapy. Since neurological disorders are rarely associated with the use of anti-TNF-α therapy in psoriatic patients, but have severe side effects, physicians should screen patients before starting therapy, excluding a positive anamnesis for demyelinating disease; if patients receiving anti-TNF-α drugs develop new or unusual neurological symptoms, the anti-TNF-α should be stopped and patients should be properly examined. Furthermore, therapies for demyelinating diseases that could exacerbate psoriasis manifestations should be carefully avoided.
authors.affiliation: Department of Medicine and Health Sciences &quot;Vincenzo Tiberio&quot;, University of Molise, Campobasso, Italy - maddy.napolitano@gmail.com.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Napolitano
authors.affiliation: Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Balato
authors.affiliation: Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ayala
authors.affiliation: Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cirillo
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples &quot;Federico II&quot;, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Balato
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D000068800:Etanercept / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000139:chemically induced*; D011565:Psoriasis / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept