Emergence of Rheumatoid Arthritis Following Exposure to Natalizumab

We report a patient with relapsing-remitting multiple sclerosis, who developed rheumatoid arthritis after exposure to natalizumab. While some multiple sclerosis therapies are known to unmask autoimmune conditions, natalizumab is rarely implicated as a cause of alternative autoimmunity. This case illustrates an unusual clinical scenario which may support recent scientific work suggesting that when natalizumab blocks T helper 1 cells from entering the central nervous system, T helper 17 cells may continue to migrate into immune-privileged spaces and cause pathologic inflammation.Brief Background: Multiple sclerosis (MS) patients often suffer from concurrent autoimmune conditions, and may be at increased risk for developing rheumatoid arthritis [1,2]. While alemtuzumab and rituximab are known to unmask underlying autoimmune disorders, natalizumab is not commonly associated with autoimmunity. Here, we report a patient with relapsing-remitting MS who developed acute autoimmune arthropathy following exposure to natalizumab.Case Report: A 45-year-old woman with autoimmune thyroiditis presented after episodes of left arm and right leg numbness. MRI showed multiple supratentorial and spinal cord demyelinating lesions. Lumbar puncture yielded CSF with a lymphocytic pleocytosis (11 leukocytes, 97% lymphocytes), normal protein, normal glucose, elevated immunoglobulin G index (2.24), and multiple unmatched oligoclonal bands. Her initial autoimmune workup revealed elevated anti-thyroid per...
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research

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Source: SafetyLit - Category: International Medicine & Public Health Tags: Alcohol and Other Drugs Source Type: news
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Source: SafetyLit - Category: International Medicine & Public Health Tags: Economics of Injury and Safety, PTSD, Injury Outcomes Source Type: news
So I inherited a patient on actiq and fentanyl patch for>6 years. She states its the only thing that works. I told her Actiq is usually only for cancer pain and she showed me the REMS registration that says it can be used for non cancer pain. I am still planning on telling her to find another provider because I don't feel comfortable having patients on that. Is that unreasonable of me? She has been taking the medication safely for many years but I simply do not feel comfortable with... Actiq for chronic pain
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Pain Medicine Source Type: forums
Publication date: Available online 26 February 2020Source: Surgery (Oxford)Author(s): Bob Yang, Steve Foley
Source: Surgery (Oxford) - Category: Surgery Source Type: research
Degenerative spondylolisthesis with or without spondylolysis, multiply recurrent disk herniation, and degenerative disk disease commonly presents as back and leg pain, weakness and paresthesias. Surgical intervention, to include lumbar decompression with instrumented fusion with or without interbody fusion, is recommended to patients who are refractory to at least six weeks of nonoperative treatment, or patients with severe or progressive neurological deficits. This paper reviews the pre- and post-operative considerations, as well as the surgical technique, for a minimally invasive transforaminal lumbar interbody fusion fo...
Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: Surgical Technique Source Type: research
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Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: Primary Research Source Type: research
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Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: Primary Research Source Type: research
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Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Pain Medicine Source Type: forums
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Source: International Journal of Rheumatic Diseases - Category: Rheumatology Authors: Tags: ORIGINAL ARTICLE Source Type: research
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Source: International Journal of Rheumatic Diseases - Category: Rheumatology Authors: Tags: ORIGINAL ARTICLE Source Type: research
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