Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review

Abstract

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.

A Rare Case of a Balo's Concentric Sclerosis-Like Lesion in a Young Adult Woman

“…Our patient's negative oligoclonal bands in addition to the "onion bulb" lesion discovered on MRI suggested that her condition was a demyelinating disorder distinct from MS. BCS physiopathology is unclear, although several mechanisms have been proposed [9]. A link between autoimmune disorders, such as JIA, and demyelination has been reported, but predisposing factors remain unclear [10,11].…”

A case of concomitant juvenile idiopathic arthritis (JIA) and paediatric-onset multiple sclerosis (POMS) – treatment with secukinumab and dimethyl fumarate followed by ofatumumab

“…However, due to insufficient data, it is extremely difficult to determine what mechanism exists between the common course of JIA and MS. Potential methods of treatment still remain unknown and therefore present a great challenge for clinicians [8].…”