Tumor necrosis factor-alpha (TNF-alpha) is a cytokine of known proinflammatory properties produced by cells of the monocyte-macrophage lineage and lymphocytes in certain infectious or immunologicalcontexts . There is a substantial body of evidence supporting its role as inflammatory mediator in autoimmune diseases. At present, TNF-alpha inhibitors constitute an effective treatment against many of these pathologies including psoriasis . In multiple sclerosis (MS) patients, TNF-alpha levels increase in serum and in cerebrospinalfluid to an extent that depends on the phase of activity of the disease . TNF-alpha production is higher before exacerbations . Furthermore, a higher number of cells express TNF-alpha mRNA in active acute and chronic demyelinating lesions than in inactive or remyelinating lesions . Although TNF-alpha antagonists have shown promising results in experimental allergic encephalomyelitis 6, 7, clinical trials with MS patients had to be suspended because of the increased number and severity of relapses 8, 9. Some cases of demyelinating events have also been noticed in relation to their use 10-18.In this article, we describe a patient who presented the first attack of MS during a course of etanercept treatment (a fusion protein composed of the soluble membrane of TNF-alpha p75 and the constant fraction of IgG1) for psoriatic arthritis.
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