Possible link between rheumatoid arthritis and multiple sclerosis

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Possible link between rheumatoid arthritis and multiple sclerosis



May 18, 2006



Gandey

Besançon, France - Evidence is mounting suggesting that multiple

sclerosis (MS) is a T-cell-mediated autoimmune disease similar to

rheumatoid arthritis (RA), with genetic and environmental factors

playing a role in their pathogenesis. Reporting in the May 2006 issue

of the Journal of Rheumatology, researchers identify an association

between the two conditions [1]. " Since a great proportion of our

patients developed MS first and subsequently RA, the best explanation

for these cases is a predisposition in MS patients to develop another

autoimmune disease with common etiologic cofactors, " comment the

investigators, led by Dr Éric Toussirot (University Hospital

Besançon, France).

" In our series, MS did not seem to have an influence on the clinical

course of arthritis, and vice versa, " they explain. " The concurrence

of MS in our patients did not prevent joint damage in most cases and

thus—despite the neurologic disease—RA will probably continue to

progress. "

But given the potential for neurological adverse events with anti-TNF

therapy, the researchers caution clinicians about these drugs. " We

recommended the careful evaluation of patients with RA before anti-

TNF- administration and the avoidance of this treatment in those

with preexisting MS diagnosis, a history of unexplained central

neurologic signs, or a family history of MS. "

Risk of neurological adverse events with anti-TNF therapy

In a separate paper, also published in the Journal of Rheumatology,

another group of investigators highlight the potential risk of anti-

TNF therapy [2]. The team, led by Dr Jarand (University of

Calgary, AB), describes three patients who developed neurological

disease associated with the use of infliximab, a monoclonal antibody

that binds to and inactivates TNF-. " All had evidence of

polyneuropathy, demyelinating in one and axonal in two, " they note.

" One patient had a central nervous system syndrome. " The researchers

emphasize that physicians should be aware of these potential adverse

effects when treating patients with infliximab.



MS is the most frequent demyelinating disease.





Toussirot and his team point out that MS is the most frequent

demyelinating disease and has been associated with various chronic

inflammatory diseases. In their retrospective study, the

investigators evaluate the association between MS and RA.

Physicians from the Club Rhumatismes et Inflammation, a subgroup of

the French society of rheumatology, were asked to report cases of MS

and RA occurring in the same patient. A rheumatologist was required

for the diagnosis of RA and a neurologist for the diagnosis of MS.

They identified 14 patients, which included 12 men and two women. RA

was diagnosed before MS in three cases while MS preceded RA in 10

cases. The diseases were identified simultaneously in one case.



It is reasonable to consider that patients with MS are prone to

develop other autoimmune diseases.





The researchers excluded patients on previous anti-TNF therapy. They

analyzed age at RA and MS onset, extra-articular disease, joint-space

narrowing, and erosions on hand or foot radiographs, rheumatoid

factors, antinuclear antibodies, treatments for RA, disease course of

MS, neurologic symptoms, brain and spinal-cord magnetic resonance

imaging findings, cerebrospinal-fluid analysis, visual evoked

potential results, and MS treatments, as well as patient outcome.

Toussirot and colleagues observed radiographic erosions in 11 cases

and joint-space narrowing in nine cases. Rheumatoid factor was

positive in six cases and antinuclear antibodies were found in only

four cases. The treatments they received were mainly methotrexate,

and other disease-modifying antirheumatic drugs were rarely used.

Most patients received corticosteroids for their arthritis.

Treatments for MS were mainly intravenous methylprednisolone,

immunosuppressive drugs, and interferon-.

The investigators found that MS usually occurred between 20 and 40

years of age, while the onset of RA was generally between the fourth

and sixth decade. They conclude, " Autoimmunity in MS is well

demonstrated, and it is reasonable to consider that patients with MS

are prone to develop other autoimmune diseases. "







Sources



Toussirot E, Pertuiset E, A, et al. Association of rheumatoid

arthritis with multiple sclerosis: Report of 14 cases and discussion

of its significance. J Rheumatol 2006; 33:1027-1028. 

Jarand J, Zochodne DW, LO, et al. Neurological complications

of infliximab. J Rheumatol 2006; 33:1018-1020. 

http://www.jointandbone.org/viewArticle.do?primaryKey=701043