Chighizola Cecilia Beatrice, Ferrito Matteo, Marelli Luca, Pontikaki Irene, Nucci Paolo, Miserocchi Elisabetta, Caporali Roberto
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
Paediatric Rheumatology Unit, ASST G. Pini & CTO, 20122 Milan, Italy.
Biomedicines. 2022 Aug 21;10(8):2041. doi: 10.3390/biomedicines10082041.
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.
幼年特发性关节炎（JIA）是儿童时期最常见的风湿性疾病，而多发性硬化症（MS）是一种中枢神经系统脱髓鞘疾病，其特征为缓解期和加重期。MS与风湿性疾病，特别是类风湿关节炎之间的关联已被描述，许多研究认为抗TNF-α药物是MS的诱发因素。相反，MS与JIA之间的关联在文献中仅报道过5例。我们描述了2例患有长期JIA及JIA相关葡萄膜炎的成年患者，他们后来患上了MS。首例患者在服用甲氨蝶呤和阿达木单抗时出现头晕和恶心。脑脊液中典型的MRI病变和寡克隆带导致了MS的诊断。停用阿达木单抗，她接受了3次静脉注射甲泼尼龙冲击治疗。几个月后，开始使用利妥昔单抗。第二例患者曾接受抗TNF-α治疗，然后改用阿巴西普。她主诉单侧手臂和面部感觉异常；脑部MRI显示典型病变，诊断为MS。给予3次静脉注射甲泼尼龙冲击治疗；神经系统疾病保持稳定，重新使用阿巴西普。有必要进行进一步研究以确定JIA与MS之间是否存在关联、MS是否代表JIA的合并症，或者抗TNF-α是否是MS发病的基础。
