Glial Fibrillary Acidic Protein (GFAP) Autoimmunity in the Setting of Seropositive Rheumatoid Arthritis Treated with Etanercept

Kelsey M. Smith; Shreyasee Amin; Lyell K. Jones; Daniel H. Lachance; Eoin P. Flanagan; Mark E. Jentoft; Orhun H. Kantarci

doi:10.1097/NRL.0000000000000243

Glial Fibrillary Acidic Protein (GFAP) Autoimmunity in the Setting of Seropositive Rheumatoid Arthritis Treated with Etanercept

Kelsey M. Smith, Shreyasee Amin, Lyell K. Jones, Daniel H. Lachance, Eoin P. Flanagan, Mark E. Jentoft, Orhun H. Kantarci

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Introduction:Glial fibrillary acidic protein (GFAP) immunoglobulin G is a recently discovered biomarker of an autoimmune central nervous system disorder characterized by a steroid-responsive meningoencephalomyelitis.Case Report:A 63-year-old man with rheumatoid arthritis on etanercept presented with steroid-responsive subacute encephalopathy and foot drop. Brain and sural nerve biopsies demonstrated a T-cell perivascular infiltrate. Cerebrospinal fluid studies 18 months into the course of the illness demonstrated a GFAP antibody on mouse tissue immunofluorescence confirmed by cell-based assay. The patient was treated with steroids and cyclophosphamide leading to resolution of his symptoms.Conclusion:This case expands on the previously reported cases of GFAP immunoglobulin G autoimmunity by describing an associated inflammatory large fiber peripheral neuropathy.

Original language	English (US)
Pages (from-to)	152-154
Number of pages	3
Journal	Neurologist
Volume	24
Issue number	5
DOIs	https://doi.org/10.1097/NRL.0000000000000243
State	Published - Sep 1 2019

Keywords

GFAP
TNF-inhibitor
encephalopathy
neuroimmunology
neuropathy

ASJC Scopus subject areas

Clinical Neurology

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10.1097/NRL.0000000000000243

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title = "Glial Fibrillary Acidic Protein (GFAP) Autoimmunity in the Setting of Seropositive Rheumatoid Arthritis Treated with Etanercept",

abstract = "Introduction:Glial fibrillary acidic protein (GFAP) immunoglobulin G is a recently discovered biomarker of an autoimmune central nervous system disorder characterized by a steroid-responsive meningoencephalomyelitis.Case Report:A 63-year-old man with rheumatoid arthritis on etanercept presented with steroid-responsive subacute encephalopathy and foot drop. Brain and sural nerve biopsies demonstrated a T-cell perivascular infiltrate. Cerebrospinal fluid studies 18 months into the course of the illness demonstrated a GFAP antibody on mouse tissue immunofluorescence confirmed by cell-based assay. The patient was treated with steroids and cyclophosphamide leading to resolution of his symptoms.Conclusion:This case expands on the previously reported cases of GFAP immunoglobulin G autoimmunity by describing an associated inflammatory large fiber peripheral neuropathy.",

keywords = "GFAP, TNF-inhibitor, encephalopathy, neuroimmunology, neuropathy",

author = "Smith, {Kelsey M.} and Shreyasee Amin and Jones, {Lyell K.} and Lachance, {Daniel H.} and Flanagan, {Eoin P.} and Jentoft, {Mark E.} and Kantarci, {Orhun H.}",

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AU - Smith, Kelsey M.

AU - Amin, Shreyasee

AU - Jones, Lyell K.

AU - Lachance, Daniel H.

AU - Flanagan, Eoin P.

AU - Jentoft, Mark E.

AU - Kantarci, Orhun H.

PY - 2019/9/1

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N2 - Introduction:Glial fibrillary acidic protein (GFAP) immunoglobulin G is a recently discovered biomarker of an autoimmune central nervous system disorder characterized by a steroid-responsive meningoencephalomyelitis.Case Report:A 63-year-old man with rheumatoid arthritis on etanercept presented with steroid-responsive subacute encephalopathy and foot drop. Brain and sural nerve biopsies demonstrated a T-cell perivascular infiltrate. Cerebrospinal fluid studies 18 months into the course of the illness demonstrated a GFAP antibody on mouse tissue immunofluorescence confirmed by cell-based assay. The patient was treated with steroids and cyclophosphamide leading to resolution of his symptoms.Conclusion:This case expands on the previously reported cases of GFAP immunoglobulin G autoimmunity by describing an associated inflammatory large fiber peripheral neuropathy.

AB - Introduction:Glial fibrillary acidic protein (GFAP) immunoglobulin G is a recently discovered biomarker of an autoimmune central nervous system disorder characterized by a steroid-responsive meningoencephalomyelitis.Case Report:A 63-year-old man with rheumatoid arthritis on etanercept presented with steroid-responsive subacute encephalopathy and foot drop. Brain and sural nerve biopsies demonstrated a T-cell perivascular infiltrate. Cerebrospinal fluid studies 18 months into the course of the illness demonstrated a GFAP antibody on mouse tissue immunofluorescence confirmed by cell-based assay. The patient was treated with steroids and cyclophosphamide leading to resolution of his symptoms.Conclusion:This case expands on the previously reported cases of GFAP immunoglobulin G autoimmunity by describing an associated inflammatory large fiber peripheral neuropathy.

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KW - TNF-inhibitor

KW - encephalopathy

KW - neuroimmunology

KW - neuropathy

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Glial Fibrillary Acidic Protein (GFAP) Autoimmunity in the Setting of Seropositive Rheumatoid Arthritis Treated with Etanercept

Abstract

Keywords

ASJC Scopus subject areas

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