title: DADS neuropathy associated with anti-TNF-α therapy.
abstract: A 52-year-old man with idiopathic Parkinson's disease and severe rheumatoid arthritis presented with a 1-year history of progressively worsening limb paraesthesia. Examination showed sensory loss in a glove and stocking distribution, absent reflexes and unsteady tandem gait. Nerve conduction studies suggested an acquired peripheral neuropathy with distal demyelination, which-together with the clinical phenotype-was consistent with a Distal Acquired Demyelinating Symmetric (DADS) neuropathy pattern. This was attributed to therapy with adalimumab, an antitumor necrosis factor (TNF)-α agent, which the patient had been taking for 2 years for rheumatoid arthritis. One month after discontinuing adalimumab, the limb paraesthesia had resolved completely and the patient had a normal tandem gait. Demyelinating disorders may rarely occur as complications of anti-TNF-α agents and therefore have implications for pretreatment counselling and ongoing monitoring. DADS neuropathy is a subtype of chronic inflammatory demyelinating polyradiculoneuropathy, which responds poorly to standard therapy and has not previously been described with anti-TNF-α therapy.
authors.affiliation: Department of Neurology, Cork University Hospital, Cork, Ireland.
authors.forename: Ronan Niall
authors.initials: RN
authors.lastname: McGinty
authors.affiliation: Department of Neurophysiology, Cork University Hospital, Cork, Ireland.
authors.forename: Brian
authors.initials: B
authors.lastname: McNamara
authors.affiliation: Bon Secours Hospital, Tralee, Ireland.
authors.forename: Helena
authors.initials: H
authors.lastname: Moore
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000139:chemically induced* / Q000175:diagnosis; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab