A case of leukoencephalopathy associated with adalimumab-treated rheumatoid arthritis and a review of literature.

Tumor necrosis factor-alpha (TNF-alpha) inhibitor is recently being widely used to treat autoimmune diseases, but some noticeable adverse events were reported and neurological events have especially been described. It is mandatory to compare these cases for finding the risk factors, the duration of the neurological events, their processes and their outcomes. We present here the case of leukoencephalopathy secondary to adalimumab, which is a tumor necrosis factor α (TNF-α) inhibitor. We also reviewed the other 14 published leukoencephalopathy cases associated with the use of TNF inhibitors. Eleven patients had underlying rheumatoid arthritis, and the others had psoriatic arthritis, ankylosing spondylitis and Still's disease. The median duration of treatment with anti-TNF-α before the presentation of neurological symptoms was 9.2 months (range: 1.5-24). The duration of using anti-TNF-α was not related with the outcome. Although cases of neurological adverse events associated with anti-TNF-α treatment are rare, it is very important to monitor the neurological signs and symptoms suggestive of a demyelinating disorder in RA patients who are receiving anti-TNF-α treatment and especially those patients who are older and who have a history of MS or demyelination.