A 45-year-old woman was presented with progressive visual problems, gait impairment and urinary dysfunction. The patient had a history of Graves’ disease, Sjogren disease and cystic nodular acne for about a decade. Over the past 4 years, she had underwent adalimumab therapy with excellent clinical response. Her evaluation revealed MRI lesions typical for MS, positive CSF for oligoclonal bands without bands in the serum (pattern 2) and the patient was diagnosed with Primary Progressive Multiple Sclerosis as per 2017 McDonald criteria.
Results
Answer – d) Stop adalimumab and administer high-dose steroids
- Anti-TNFα drugs, being effective and safe, have changed the course of autoimmune disease management. Evidences have demonstrated the appearance of demyelinating disorders of the peripheral and CNS in patients with autoimmune disorders like rheumatoid arthritis highlighting that anti-TNFα can increase the risk of demyelinating events by about 30%. At the onset of unexplained neurological symptoms, anti-TNFα therapy must be discontinued. Although, there are no guidelines for the management of drug-induced demyelinating CNS lesions, the primary tool is to administer steroids.
Answer – d) Stop adalimumab and administer high-dose steroids
- Anti-TNFα drugs, being effective and safe, have changed the course of autoimmune disease management. Evidences have demonstrated the appearance of demyelinating disorders of the peripheral and CNS in patients with autoimmune disorders like rheumatoid arthritis highlighting that anti-TNFα can increase the risk of demyelinating events by about 30%. At the onset of unexplained neurological symptoms, anti-TNFα therapy must be discontinued. Although, there are no guidelines for the management of drug-induced demyelinating CNS lesions, the primary tool is to administer steroids.
