Guillain-Barrè syndrome after treatment with anti-tumour necrosis factor α (etanercept) in a rheumatoid arthritis patient: Case report and literature review

Abstract

Rheumatoid arthritis (RA) is often treated with anti-tumor necrosis factor α (anti-TNF-α) medications. While these drugs can cause common side effects such as injection-site and infusion reactions, rare cases of Guillain-Barré syndrome (GBS) have been reported. It's a potentially life-threatening condition characterized by progressive, ascending weakness of the extremities and areflexia, with an incidence of about 1.5 cases per 100,000 annually and a mortality rate of around 5%. It has been linked to various triggers, including infections, vaccinations, and medications like TNF inhibitors. Anti-TNF-α treatments may induce GBS by activating latent infections, increasing susceptibility, triggering autoimmune responses, or disrupting the balance of TNF-α in the peripheral nervous system. We report a 39-year-old female with a 26-year history of RA, initially treated with methotrexate until it was discontinued due to myelosuppression. She was then prescribed etanercept. A few weeks later, she developed numbness and burning pain in her limbs. GBS was suspected based on her symptoms, and nerve conduction studies confirmed the diagnosis. She was successfully treated with plasmapheresis.