Tumor necrosis factor alpha inhibitors and demyelinating disease: what is behind it?

Abstract

The development of tumor necrosis factor alpha (TNF-) inhibitors is probably one of the most significant advancement in the management of a number of inflammatory rheumatic disorders to date. High efficacy of the treatment is associated with relatively rare and very heterogeneous adverse reactions. The reactions are gradually recognized with an increase in number of the patients receiving medication and prolonged period of the drug usage. Neurological adverse events in patients receiving TNF- inhibitors are not common. This finding emergence a question of coincidental occurrence of the nervous system involvements as opposite to suggestion of induction of the nervous system disease or unmasking of latent disease due to the drug administration. Potential association of anti-TNF- therapy with demyelination is one of neurological adverse reaction, and is an important concern for every day clinical practice of rheumatologist as well as is an interesting problem from pathophysiological point of view.