Chronic inflammatory demyelinating polyneuropathy associated with tumor necrosis factor‐α antagonists

Abstract

Biologic therapy with tumor necrosis factor (TNF)-alpha antagonists for rheumatoid arthritis has been well established. We describe two patients with rheumatoid arthritis who developed chronic inflammatory demyelinating polyneuropathy (CIDP) during their course of therapy with TNF-alpha antagonists. A 45-year-old woman and a 49-year-old man, both with a history of rheumatoid arthritis, were treated with etanercept and infliximab, respectively. Clinical signs of peripheral neuropathy developed 2 weeks and 12 months after the initiation of TNF-alpha antagonists. Electrodiagnostic studies at variable points during the disease course showed signs of acquired demyelination consistent with CIDP. Cerebrospinal fluid examination showed albuminocytologic dissociation (total protein concentration 118 mg/dl and 152 mg/dl, respectively). Both patients failed to improve after discontinuation of the offending agent, and they responded poorly to corticosteroids. However, there was clinical and electrophysiologic recovery after initiation of intravenous immunoglobulin (IVIg) therapy. CIDP may occur early or late during the treatment course with TNF-alpha antagonists. IVIg may reverse and stabilize the inflammatory process.

Peripheral neuropathy electrophysiological screening in inflammatory bowel disease

“…All commonly used medications for IBD were used in our sample, including TNF-a inhibitors, which have been linked to PN or other neurological complications [23]. Therefore, in these terms, the group is considered representative of the common clinical practice in a gastroenterology clinic.…”

Neuropsychiatric manifestations in rheumatoid arthritis

“…Demyelinating peripheral neuropathy. Acute, subacute and chronic demyelinating polyradiculoneuropathy have been reported in patients with RA, especially those who receiving anti-TNF alpha [95]. Clinical course is a chronically relapsing or progressive symmetric sensorimotor disorder with cytoalbuminologic dissociation on cerebrospinal fluid analysis.…”

Drug-induced dysimmune demyelinating neuropathies

“…Case histories and small series report on a spectrum of inflammatory demyelinating neuropathic syndromes [27], with additional cases reported of GBS [28], CIDP [29,30], MMNCB [31][32][33], LSS [34], and an acute sensorimotor demyelinating polyneuropathy [35]. (Post-marketing surveillance [http://www.fda.gov/cder/handbook/medwatch.htm] and literature review determined no neuropathies during treatment with more recently introduced golimumab and certolizumab.…”