Neurological Complications during Anti-TNF Therapy: A Prospective Imaging and Electrophysiological Study

Evripidis Kaltsonoudis¹, Anastasia Zikou², Paraskevi V. Voulgari³, Spyridon Konitsiotis⁴, Maria Argyropoulou⁵ and Alexandros A. Drosos⁶, ¹Rheumatology Clinic, Department of Internal Medicine, Rheumatologist, Ioannina, Greece, ²Department of Clinical Imaging and Radiology, Medical School, University of Ioannina, Ioannina, Greece, Lecturer of Radiology, Ioannina, Greece, ³Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Associate Professor of Rheumatology, Ioannina, Greece, ⁴Department of Neurology, Associate Professor of Neurology, Ioannina, Greece, ⁵Department of Clinical Imaging, Professor of Radiology, Ioannina, Greece, ⁶Rheumatology Clinic, Department of Internal Medicine, University of Ioannina, Ioannina, Greece

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: anti-TNF therapy and neurologic involvement, MRI

Session Information

Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging (MRI)

Session Type: Abstract Submissions (ACR)

Background/Purpose The aim was to investigate the frequency of neurological adverse events in patients with rheumatoid arthritis (RA) and spondylarthropathies (SpA) treated with tumor necrosis factor (TNF) α antagonists.

Methods Seventy-seven patients eligible for anti-TNFα therapy were evaluated. There were 36 patients with RA, 41 with SpA (24 psoriatic arthritis [PsA] and 17 with ankylosing spondylitis [AS]). All patients had a complete physical and neurological examination. Brain and cervical spine magnetic resonance imaging (MRI) and neurophysiological tests were performed in all patients before the initiation of anti-TNFα therapy and after a mean of 18 months or when clinical symptoms and signs indicated a neurological disease. Exclusion criteria included hypertension, diabetes mellitus, dyslipidemia, heart arrhythmias, atherothrombotic events, vitamin 12 and iron deficiency, head and neck trauma and neurological surgeries.

Results Two patients did not receive anti-TNFα therapy because brain MRIs at baseline revealed lesions compatible with demyelinating diseases. Thus, 75 patients received anti-TNFα (38 infliximab, 19 adalimumab and 18 etanercept). Three patients developed neurological adverse events. A 35-year-old man with PsA after 8 months of infliximab therapy presented with paresis of the left facial nerve and brain MRI showed demyelinating lesions. Infliximab was discontinued and he was treated with pulses of corticosteroids recovering completely after two months. The second patient was a 45-year-old woman with RA who after 6 months of adalimumab therapy presented with optic neuritis. The third patient was a 50-year-old woman with AS, whom after 25 months of infliximab therapy, presented with tingling and numbness of the lower extremities and neurophysiological tests revealed peripheral neuropathy. In both patients anti-TNF were discontinued and they improved without treatment after 2 months. The rest of our patients showed no symptoms and MRIs showed no abnormalities.

Conclusion Neurological adverse events after anti-TNFα therapy were observed in our patient. The estimated rate of neurological complications is 4% (3/75). Brain MRI and neurophysiological tests are essential tools to discriminate neurological diseases.

Disclosure:

E. Kaltsonoudis,
None;

A. Zikou,
None;

P. V. Voulgari,
None;

S. Konitsiotis,
None;

M. Argyropoulou,
None;

A. A. Drosos,
None.

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