The Journal of the Arkansas Medical Society Issue 5 Volume 115 | Page 21
velopment of multiple sclerosis-like symptoms.
This SNP, (rs1800693) however, does not occur in
rheumatoid arthritis or other autoimmune diseases
like psoriasis or Crohn’s disease. 14 This SNP, how-
ever, predisposes to primary biliary cirrhosis. 16 It
has been proposed that this SNP may predispose
to increased demyelination upon exposure to TNF
antagonists. 14 Routine genotyping for these predis-
posing SNPs may not be clinically feasible.
Our patient continues to have multiple joint
problems, including shoulder and hip pain, and fre-
quent knee joint problems. Our patient was started
on abatacept as an alternative biologic, after discus-
sion of the possibility of use of tocilizumab, tofaci-
tinib, and rituximab. The continued need for use of
these biologics also raised suspicion for paraneo-
plastic condition, which is currently being evaluated.
In summary, the present case highlights that
use of TNF– α agent etanercept may cause mul-
tiple sclerosis-like symptoms including fatigue and
personality changes, sensory deficits, and neuromy-
opathy, including diplopia due to involvement of the
cranial nerves supplying the extraocular muscles.
Aggressive identification of evolving symptoms shall
prevent adverse neurologic outcomes.
Addendum: The association and clinical presentation
shall be reported to the FDA Medwatch.
References
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Advertise in
the best place
to reach 4,400
Arkansas
physicians
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