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Updated: Aug 19, 2025

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Therapeutic consequences in patients with both inflammatory rheumatic diseases and multiple sclerosis.

Jean-Guillaume Letarouilly1, Patrick Vermersch2, René-Marc Flipo1

  • 1Université de Lille, CHU Lille, FHU PRECISE, Service de Rhumatologie, Lille, France.

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|November 28, 2022
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Summary

Treating patients with multiple sclerosis (MS) and inflammatory rheumatic disorders (IRDs) requires careful consideration of disease-modifying drugs (DMARDs). Recent evidence suggests TNF inhibitors may be safe for MS patients with IRDs, challenging previous contraindications.

Keywords:
PsARATNF inhibitorbDMARDmultiple sclerosisspondyloarthritis

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Area of Science:

  • Rheumatology and Neurology
  • Immunology and Inflammation

Background:

  • Co-occurrence of multiple sclerosis (MS) and inflammatory rheumatic disorders (IRDs) is increasingly recognized.
  • A statistical association exists between spondyloarthritis (SpA) and MS.
  • Previous concerns regarding TNF inhibitors (TNFi) in MS patients stemmed from limited trial data, not large-scale epidemiology.

Approach:

  • This review synthesizes current literature on the interplay between MS and IRDs.
  • It examines the impact of various disease-modifying antirheumatic drugs (DMARDs) on MS, with a specific focus on TNFi.
  • The review also considers the implications of MS-specific disease-modifying therapies in patients with co-existing IRDs.

Key Points:

  • Epidemiological studies suggest TNFi may not induce MS, questioning the absolute contraindication.
  • Clear guidelines for using other DMARDs in patients with both MS and IRDs are lacking.
  • Understanding the safety and efficacy of DMARDs in this complex patient population is crucial.

Conclusions:

  • The contraindication for TNFi in patients with pre-existing demyelinating disease requires re-evaluation based on current epidemiological data.
  • Further research is needed to establish definitive recommendations for DMARD use in patients with comorbid MS and IRDs.
  • A nuanced approach is necessary for managing patients with both autoimmune conditions.