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Letarouilly JG, Vermersch P, Flipo RM. Therapeutic consequences in patients with both inflammatory rheumatic diseases and multiple sclerosis. Rheumatology (Oxford) 2023; 62:2352-2359. [PMID: 36440887 DOI: 10.1093/rheumatology/keac665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/19/2022] [Indexed: 07/20/2023] Open
Abstract
Dealing with patients with both multiple sclerosis (MS) and inflammatory rheumatic disorders (IRDs) is not uncommon for a rheumatologist, as there is a statistical association between SpA and MS. As several CNS demyelinating events have been reported in patients treated with TNF inhibitor (TNFi), the pre-existing demyelinating disease was considered a contraindication for TNFi. However, this contraindication is mainly based on a randomized controlled trial in MS and not on large epidemiological studies. According to the last epidemiological studies, TNFi might not be an inducer of MS. Moreover, there are no clear recommendations on the use of the other DMARDs in patients suffering from an IRD and MS. In this review, we summarize the link between MS and IRDs and the impact of DMARDs on MS, especially TNFi. We also look at the impact of disease-modifying drugs for adults with MS and IRDs.
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Affiliation(s)
| | - Patrick Vermersch
- Université de Lille, CHU Lille, INSERM UMR1172 LilNCog, FHU PRECISE, Service de Neurologie, Lille, France
| | - René-Marc Flipo
- Université de Lille, CHU Lille, FHU PRECISE, Service de Rhumatologie, Lille, France
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Romozzi M, Bellavia S, Caldarola G, De Simone C, Luigetti M, Calabresi P, Di Filippo M, Masullo C, Lucchini M. Ixekizumab exposure associated with myelitis: A case report and a literature review. J Neuroimmunol 2021; 361:577726. [PMID: 34628135 DOI: 10.1016/j.jneuroim.2021.577726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022]
Abstract
We describe a case of a 28-year-old man who developed a cervical myelitis while exposed to ixekizumab (IL-17 inhibitor) for psoriatic arthritis. Spinal MRI showed a T2 hyperintense lesion at the C4-C5 level while brain MRI was unspecific. Oligoclonal bands were absent and extensive screening for autoimmunity was negative. Rechallenge with ixekizumab was positive corroborating a relation between drug exposure and the neurological event. To the best of our knowledge, this is the first case of CNS inflammatory adverse event associated with ixekizumab. We also provide a review of case reports of demyelinating disorders associated with the use of biologic drugs for the treatment of psoriasis and psoriatic arthritis.
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Affiliation(s)
- Marina Romozzi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Simone Bellavia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Caldarola
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clara De Simone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Carlo Masullo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Lucchini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
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Barešić M, Reihl Crnogaj M, Zadro I, Anić B. Demyelinating disease (multiple sclerosis) in a patient with psoriatic arthritis treated with adalimumab: a case-based review. Rheumatol Int 2021; 41:2233-2239. [PMID: 34557936 DOI: 10.1007/s00296-021-04995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Over the past two decades, tumor necrosis factor-α (TNF-α) inhibitors became one of the most important drugs in the treatment of patients with psoriatic arthritis. Unfortunately, some of the patients exhibit unwanted side effects of the treatment. We describe a patient with psoriasis, psoriatic arthritis and uveitis who was treated with adalimumab and after 4 months of the treatment developed clinical and neuroradiological signs of demyelinating disease of the central nervous system. She experienced no signs and symptoms of neurological disease prior to adalimumab administration. After a detailed neurological work-up she was diagnosed with relapsing-remitting type of multiple sclerosis and treated with oral and pulse glucocorticoids and later with dimethyl fumarate. Adalimumab was discontinued. The question remains was the demyelination induced by the TNF-α blockade or was it unmasked by the introduction of the cytokine blocking agent. In patients suffering from inflammatory arthritis, treating disease to target as well as a close follow-up and knowledge of potential side effects of treatment remains crucial in good clinical practice.
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Affiliation(s)
- Marko Barešić
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.
| | - Mirna Reihl Crnogaj
- Division of Physical Medicine, Rehabilitation and Rheumatology, National Memorial Hospital Vukovar, Vukovar, Croatia
| | - Ivana Zadro
- Department of Neurology, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Branimir Anić
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
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