CASE REPORT - RA complicated by demyelination in both the cerebral cortex and spinal cord during Enbrel therapy

May 2, 2008

Mod Rheumatol. 2008 Apr 15

A case of rheumatoid arthritis complicated by demyelination in both

cerebral cortex and spinal cord during etanercept therapy.

Kameda T, Dobashi H, Kittaka K, Susaki K, Hosomi N, Deguchi K, Ishida T.

First Department of Internal Medicine, Division of Endocrinology and

Metabolism, Hematology, Rheumatology and Respiratory Medicine, Faculty

of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun,

Kagawa, 761-0793, Japan

Tumor necrosis factor (TNF) antagonists, including etanercept, have

been approved for the treatment of rheumatoid arthritis (RA). These

agents are not free of adverse events like other antirheumatic agents.

Several important adverse events in CNS lesions have been reported. In

this paper, we report on one patient with RA that had complications

from a demyelinating disorder during TNF-blockade therapy using

etanercept at 24 months after initial administration. A 66-year-old

Japanese woman was diagnosed with RA in 1959. She received various

disease-modifying antirheumatic drugs (DMARDs), but all of these

agents were ineffective. She was administered etanercept in June 2005,

and stayed well. Twenty-four months after the initial administration

of etanercept, she developed palsy of bilateral upper extremities and

gait disturbance subacutely, and was then admitted to our institute in

August 2007. MRI of her spinal cord revealed a high-intensity lesion

from the third through to the seventh cervical (C3-C7) levels.

Additionally, T2-weighted MRI images showed disseminated

high-intensity lesions in the white matter of brain. She was suspected

of having a demyelinating disorder based on these MRI findings. There

was no significant finding that pointed to another neurological

disorder. High-dose corticosteroid therapy was conducted and was

effective for her.

PMID: 18414783

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Not an MD

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