DADS neuropathy associated with anti-TNF-α therapy

Area of Science:

• Neurology
• Immunology

Background:

• Rheumatoid arthritis and Parkinson's disease are chronic conditions requiring immunomodulatory treatments.
• Anti-tumor necrosis factor (TNF)-α agents are widely used for autoimmune diseases like rheumatoid arthritis.
• Peripheral neuropathies can be challenging to diagnose and manage, especially when associated with complex medical histories.

Observation:

• A 52-year-old male patient with rheumatoid arthritis and Parkinson's disease developed progressive limb paresthesia over one year.
• Clinical examination revealed sensory loss in a glove and stocking distribution, absent reflexes, and gait instability.
• Nerve conduction studies indicated a distal acquired demyelinating symmetric (DADS) neuropathy.

Findings:

• The patient's symptoms were attributed to adalimumab, a TNF-α inhibitor, used for rheumatoid arthritis treatment.
• Discontinuation of adalimumab led to complete resolution of limb paresthesia and normalization of gait within one month.
• This case suggests a rare association between adalimumab therapy and the development of DADS neuropathy.

Implications:

• Demyelinating neuropathies, including DADS, can be rare adverse effects of anti-TNF-α therapies.
• Physicians should consider neuropathy in patients on anti-TNF-α agents presenting with neurological symptoms.
• Enhanced pretreatment counseling and vigilant monitoring are crucial for patients receiving anti-TNF-α therapy to detect potential neurological complications early.