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首页> 外文期刊>Arthritis research & therapy. >Neurological adverse events in patients receiving anti-TNF therapy: A prospective imaging and electrophysiological study
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Neurological adverse events in patients receiving anti-TNF therapy: A prospective imaging and electrophysiological study

机译：接受抗TNF治疗的患者的神经系统不良事件：前瞻性成像和电生理研究

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Introduction: 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 B12 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. The estimated rate of neurological adverse events in patients treated with anti-TNF therapy is 4% (3/75).Conclusions: Neurological adverse events after anti-TNFα therapy were observed in our patient. Brain MRI and neurophysiological tests are essential tools to discriminate neurological diseases.
机译：简介：目的是研究使用肿瘤坏死因子（TNF）α拮抗剂治疗的类风湿关节炎（RA）和脊椎病（SpA）患者的神经系统不良事件发生率。方法：接受抗TNFα治疗的77例患者评估。 RA患者36例，SpA患者41例[银屑病关节炎（PsA）24例，强直性脊柱炎（AS）17例]。所有患者均进行了全面的身体和神经系统检查。在开始抗TNFα治疗之前，平均18个月后或当临床症状和体征表明存在神经系统疾病时，所有患者均进行了脑和颈椎磁共振成像（MRI）和神经生理学检查。排除标准包括高血压，糖尿病，血脂异常，心律不齐，动脉粥样硬化事件，维生素B12和铁缺乏症，头颈外伤和神经外科。结果：两名患者未接受抗TNFα治疗，因为基线脑部MRI显示病变与脱髓鞘疾病。因此，有75名患者接受了抗TNFα治疗（38种英夫利昔单抗，19种阿达木单抗和18种依那西普）。三例患者出现神经系统不良事件。一名英夫利昔单抗治疗8个月后出现左面部神经麻痹和脑部MRI的35岁男性，出现脱髓鞘性病变。英夫利昔单抗停用后，他接受了两个月后完全恢复的皮质类固醇激素治疗。第二例患者是一名45岁的RA患者，经过6个月的阿达木单抗治疗后出现视神经炎。第三例患者是一名50岁的AS患者，经过英夫利昔单抗治疗25个月后，出现下肢刺痛和麻木，神经生理学检查显示其周围神经病变。两名患者均终止抗TNF治疗，且在2个月后未经治疗即可改善。我们的其余患者均未显示任何症状，MRI也未显示异常。接受抗TNF治疗的患者的神经系统不良事件的估计发生率为4％（3/75）。结论：我们的患者中观察到抗TNFα治疗后的神经系统不良事件。脑部MRI和神经生理学检查是区分神经系统疾病的重要工具。

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