Journal of Multiple Sclerosis

A Case Report of Central Nervous System Demyelinaion in a Patient with Rheumatoid Arthritis: Is it Multiple Sclerosis?

Ichrak Ghachem, Saloua Fray, Héla Jamoussi, Meriem Ben Mahmoud, Nadia Ben Ali and Mohamed Fredj*

Background: Patients with rheumatoid arthritis (RA) may have central nerve system (CNS) comorbidities such us demyelinating lesions. In current practice, this clinical situation raises an etiological problem of this demyelination; is it linked to treatments; anti TNF drugs, which is the most frequent case? or is it a primary demyelination of the CNS?.
Case report: We reported the case of a 52-year-old woman followed for seronegative Rheumatoid arthritis (RA) treated with methotrexate that presented clinical and radiological multifocal inflammatory demyelinating lesions. No etiology related to RA or its treatment could explain the radioclinical presentation of the patient. Magnetic resonance imaging lesions fulfilling MC Donald’s criteria for Multiple Sclerosis (MS) and analysis of cerebrospinal fluid showed intrathecal synthesis of oligoclonal IgG band (OCB). All the difficulty of this medical condition lies in the etiological assessment. The diagnosis of primary demyelination, specifically multiple sclerosis associated with RA, was retained.
Conclusions: Certainly it is an infrequent case associating MS and RA in the absence of anti-TNF treatment which makes the originality of our case.