Central nervous system involvement in rheumatoid arthritis patients and the potential implications of using biological agents

Publication date: Available online 27 February 2019Source: Best Practice & Research Clinical RheumatologyAuthor(s): Fabiola Atzeni, Rossella Talotta, Ignazio Francesco Masala, Maria Chiara Gerardi, Roberto Casale, Piercarlo Sarzi-PuttiniAbstractCentral nervous system (CNS) involvement is quite unusual in patients with rheumatoid arthritis (RA), although cerebral vasculitis, rheumatoid nodules and meningitis have all been reported, and patients with RA may also have CNS comorbidities such as stroke and neuro-degenerative and demyelinating syndromes. It has been found that biological drugs, especially anti-tumour necrosis factor-alpha (anti-TNF-α) drugs, slightly increase the risk of developing demyelinating diseases, and they are consequently discouraged in patients with multiple sclerosis and related disorders. Furthermore, the risk of opportunistic CNS infections is increased in immunosuppressed patients.To review the current literature concerning CNS involvement in patients with RA (including RA-related forms and comorbidities) and the incidence of new-onset CNS diseases in patients with RA undergoing biological treatment (anti-TNF or non-anti-TNF drugs), the Medline database was searched using the key words ‘rheumatoid arthritis’, ‘central nervous system’, ‘anti-TNF’, ‘abatacept’, ‘tocilizumab’, ‘rituximab’ and ‘anakinra’. Abstracts not in English were excluded.We selected 76 articles published between 1989 and 2017, which were divided into fou...
Source: Best Practice and Research Clinical Rheumatology - Category: Rheumatology Source Type: research