Rheumatoid Arthritis in a Patient with Multiple Sclerosis Who Received INF β1-α: A Case Report

Multiple sclerosis (MS) is an autoimmune of CNS that could be present with other autoimmune disorders. On the other hand, biologic drugs make this association even more complicated because these drugs, themselves, can cause autoimmune disease. Like other diseases, there are reports of other autoimmune diseases developed by these drugs in patients with MS.

The patient was a 55-year-old woman with right-sided hemiparesthesia appearing about 4 years ago that resolved spontaneously. Two years later, she developed paresis of the right hand. With a diagnosis of MS, the patient received steroid pulse therapy with methylprednisolone 1 gr for 5 days followed by weekly intramuscular interferon β1-α. About 1.5 years after interferon therapy, the patient developed pain in the limbs, especially in hands. On examination, the wrist and metacarpophalangeal joints were tender and swollen. preclinical evaluation revealed elevated erythrocyte sedimentation rate (ESR), a very high level of anti-cyclic citrullinated peptide (anti-CCP), and a high level of RF. Rheumatoid arthritis (RA) was diagnosed for the patient.

MS, like any other autoimmune disease, can be associated with other autoimmune diseases. On the other hand, biologic drugs used to control MS can potentially cause autoimmune diseases.