title: TNF-alpha inhibitor associated myelopathies: A neurological complication in patients with rheumatologic disorders.
abstract: OBJECTIVE
  Tumor necrosis factor-alpha inhibitors (TNFα-I) are biological agents used in the treatment of rheumatologic disorders. TNFα-I have been associated with demyelinating disorders mimicking multiple sclerosis. The goal of this report is to illustrate cases of myelopathy which developed during the use of TNFα-I.
  
  
  METHODS
  We describe the clinical, neuroimaging and laboratory features of 4 cases of myelopathy associated with TNFα-I.
  
  
  RESULTS
  The mean period of TNFα-I exposure was 27 [12-36] months. Three of the four patients exhibited active inflammatory myelopathy as the spinal cord MRI lesions enhanced with gadolinium and CSF pleocytosis or oligoclonal bands were present. All patients had normal brain MRIs at the time of presentation.
  
  
  CONCLUSIONS
  TNFα-I may play a role in the development of myelopathies in absence of brain involvement or other features of demyelinating disease. TNFα-I associated myelopathy should be considered in patients with history of treatment with TNFα-I who exhibit symptoms of myelopathy.
authors.affiliation: Department of Neurology & Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Johns Hopkins Transverse Myelitis Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: pbarrer2@jhmi.edu.
authors.forename: Paula
authors.initials: P
authors.lastname: Barreras
authors.affiliation: Department of Neurology & Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Johns Hopkins Transverse Myelitis Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: mmealy1@jhmi.edu.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Mealy
authors.affiliation: Department of Neurology & Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Johns Hopkins Transverse Myelitis Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: cpardov1@jhmi.edu.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pardo
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000378:metabolism; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000187:drug effects; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Spinal cord; TNF; TNF-alpha inhibitors; Transverse myelitis