LETTER TO THE EDITOR - Peripheral neuropathy in patients with systemic rheumatic diseases treated with Arava

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ls of the Rheumatic Diseases 2005;64:1798-1800; doi:10.1136/ard.2005.038265

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LETTER

Peripheral neuropathy in patients with systemic rheumatic diseases

treated with leflunomide

C Metzler 1, A C Arlt 2, W L Gross 1, J Brandt 1

1 Department of Rheumatology, University of Schleswig-Holstein, Campus

Luebeck and Rheumaklinik Bad Bramstedt, Germany

2 Department of Neurology, Rheumaklinik Bad Bramstedt, Germany

Leflunomide (LEF) was introduced as a new disease modifying

antirheumatic drug in 1998. Up to now hepatotoxicity, hypertension,

and diarrhoea have been reported as adverse events. Peripheral

neuropathy (PNP) has been described in eight patients with rheumatoid

arthritis (RA) and psoriatic arthritis.1–3 In the postmarketing

surveillance PNP does not appear as a side effect.4

This first retrospective study aimed at evaluating whether LEF might

be associated with PNP in a large cohort of patients with inflammatory

rheumatic diseases.

All inpatients of a primary rheumatology clinic with systemic

rheumatic diseases and treatment with LEF between August 1998 and May

2004 were retrospectively screened for a new onset of PNP. Patients

with definite reasons for PNP—for example, active vasculitis or

collagenosis, diabetes mellitus, lack of vitamins, alcohol abuse, and

neoplasms, were excluded. PNP was screened clinically and confirmed by

electrophysiological examination.

Seven hundred and eighty five patients with LEF treatment were

identified. PNP was diagnosed in 106 (13.5%) patients. Ninety five

patients were excluded with diabetes (22 patients), malignoma with

cytotoxic treatment (2 patients), vasculitis (67 patients), and

connective tissue diseases (4 patients). None of the patients with PNP

and systemic rheumatic diseases potentially associated with PNP had

any history of neuropathy or any clinical or serological signs of

disease activity at the time of the first manifestation of PNP and

were, for example, in remission.

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Read the full text here:

http://ard.bmj.com/cgi/content/full/64/12/1798

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