[Multiple sclerosis as an adverse effect of anti-tumor necrosis factor agents: an infrequent but important complication of infliximab in Crohn's disease]. / Esclerosis múltiple como efecto adverso de los agentes antifactor de necrosis tumoral alfa: una complicación infrecuente pero relevante de infliximab en la enfermedad de Crohn.

Anti-tumor necrosis factor alpha (TNF-α) agents have been a great advantage in the treatment of inflammatory bowel disease. The safety profile of these agents is well-known and they can be considered safe when properly used. In clinical practice, the most important adverse events are infections. Other adverse effects are also possible but are much less frequent. However, because of the widespread use of these drugs, these uncommon adverse effects may also occur in clinical practice. We report one of these infrequent adverse events, multiple sclerosis, which is rare but important because of its severity. When neurological symptoms appear during treatment with anti-TNF-α, multiple sclerosis must be ruled out. The diagnosis and therapeutic management of this entity, led by a neurologist with our collaboration, required permanent cessation of anti-TNF-α therapy. Azathioprine, interferon, and even natalizumab, may be used as alternatives in patients who require therapy.

Hopelessness in Patients with Early-Stage Relapsing-Remitting Multiple Sclerosis.

Background: Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS. Methods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients' characteristics and state hopelessness. Results: A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders. Conclusion: Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.

Acute Acalculous Cholecystitis in a Multiple Sclerosis Patient Treated with Natalizumab.

Natalizumab is a disease-modifying drug that has proved greatly effective and well-tolerated in highly-active Multiple Sclerosis (MS). However, it may increase the risk for opportunistic infections, such as viral ones. We describe a 37-year-old woman treated with Natalizumab for Relapsing-Remitting Multiple Sclerosis (RR-MS) who presented to our clinic with malaise, arthromyalgias, rash, and fever. She later developed diarrhea and severe abdominal pain. A diagnosis of parvovirus B19 (B19V) infection and acute acalculous cholecystitis (AAC) was eventually made. To our knowledge, this is the first reported case of AAC possibly related to Natalizumab therapy and B19V infection.