Related Experiment Video

Updated: Aug 19, 2025

Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination
09:38

Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination

Published on: September 12, 2016

12.4K

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.

Rheumatology (Oxford, England)
|November 28, 2022
PubMed

Insights

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.

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.
Keywords:
PsARATNF inhibitorbDMARDmultiple sclerosisspondyloarthritis

More Related Videos

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain04:50

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain

Published on: May 16, 2025

307
An Adoptive Transfer Model of Rheumatoid Arthritis in Mice07:37

An Adoptive Transfer Model of Rheumatoid Arthritis in Mice

Published on: June 6, 2025

297

Related Concept Videos

T Cell Types and Functions01:24

T Cell Types and Functions

When T cells with CD4 markers are activated, they give rise to two types of effector cells: helper T cells and regulatory T cells. Meanwhile, T cells with CD8 markers differentiate into effector cytotoxic T cells. The differentiation of CD4 T cells into helper T cell subsets, such as Th1, Th2, and Th17 cells, is dependent on the antigen type, antigen-presenting cell, and regulatory cytokines.
Th1 cells stimulate dendritic cells to express necessary co-stimulatory molecules on their surfaces for...
1.3K
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
210
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
248
Inflammatory Bowel Disease IV: Pharmacological Management01:29

Inflammatory Bowel Disease IV: Pharmacological Management

Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
169
Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
26
Rheumatic Heart Disease IV: Nursing Management01:20

Rheumatic Heart Disease IV: Nursing Management

AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
31