Rheumatology Unit, Department of clinical and experimental medicine, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna Hospital of Ferrara, Corso Giovecca, 203-44100, Ferrara, Italy.
Rheumatol Int. 2011 Jun;31(6):715-9. doi: 10.1007/s00296-010-1760-3. Epub 2011 Jan 22.
To describe a rare association between rheumatoid arthritis (RA) and amyotrophic lateral sclerosis (ALS). Two new cases of patients with RA who developed amyotrophic lateral sclerosis (ALS), one receiving anti-TNFα agents, were reported. Only other five cases of this rare association have been previously described in literature. The simultaneous presence of the two diseases represents a difficult diagnostic challenge because RA may mimic some musculoskeletal symptoms of ALS. There is no evidence in favor of a common pathophysiologic mechanism, and thus the possibility of a fortuitous association must be raised. A neurotoxic side effect of various drugs for RA treatment could be considered. Casual or causal association remains a difficult choice. The possibility of a coincidental association must be raised but neurologic side effects of TNFα blockers lead to discussion.
描述类风湿关节炎（RA）和肌萎缩侧索硬化症（ALS）之间罕见的关联。报告了两例新的 RA 患者发生肌萎缩侧索硬化症（ALS）的病例，其中一例接受了抗 TNFα 药物治疗。这种罕见关联之前在文献中仅描述过其他五例。这两种疾病同时存在是一个具有挑战性的诊断难题，因为 RA 可能会模仿 ALS 的一些肌肉骨骼症状。没有证据支持共同的病理生理机制，因此必须提出偶然关联的可能性。RA 治疗的各种药物的神经毒性副作用可以被考虑。偶然关联或因果关联仍然是一个困难的选择。必须提出偶然关联的可能性，但 TNFα 阻滞剂的神经副作用导致了讨论。
