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Letter
No association between rheumatoid arthritis, amyotrophic lateral sclerosis, and tumour necrosis factor inhibitor treatment
  1. Elizabeth V Arkema1,
  2. Nils Feltelius2,3,
  3. Tomas Olsson4,
  4. Johan Askling1,2
  5. on behalf of the ARTIS study group
  1. 1 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2 Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3 Medical Products Agency, Uppsala, Sweden
  4. 4 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Elizabeth V Arkema, Clinical Epidemiology Unit, Department of Medicine, T2, Karolinska Institutet, Stockholm 17176, Sweden; Elizabeth.Arkema{at}ki.se

https://doi.org/10.1136/annrheumdis-2014-205622

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    The aetiology of amyotrophic lateral sclerosis (ALS) is poorly understood, and it is unclear if autoimmunity plays a role or if ALS is associated with inflammatory/autoimmune diseases such as rheumatoid arthritis (RA). There have been very few reports of patients with RA who develop ALS, and no epidemiological study examining the co-occurrence of the two diseases has been conducted.1–6 In December 2012, a cluster of ALS cases following treatment with tumour necrosis factor inhibitor (TNFi) was reported using data from the European system for reporting suspected adverse drug reactions, the EudraVigilance database.7 We sought to estimate the ALS rate in RA exposed and unexposed to TNFi using a nationwide, prospective, population-based cohort study design.

    We used Swedish national registers to identify patients with RA (National Patient Register inpatient care 1969–2011 and outpatient care 2001–2011 and the Swedish Rheumatology Quality Register 1996–2011) and TNFi exposures (Swedish Biologics Register ARTIS 1999–2011). General population comparators were selected from the total population register matched on age, sex, county and date of the matched diagnosis of patients with RA …

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    Footnotes

    • Collaborators The ARTIS Study Group: JA, NF, Eva Baecklund, Helena Forsblad, Pierre Geborek, Lennart Jacobsson, Alf Kastbom, Lars Klarskog, Lars-Erik Kristensen, Staffan Lindblad, Solbritt Rantapää-Dahlqvist, Ronald van Vollenhoven.

    • Contributors All authors contributed to the study's conception and design. EVA performed the analysis and drafted the manuscript. All authors provided critical revision and final approval. The views presented are those of the authors and do not represent an official position of the Medical Products Agency to which one of the authors (NF) is affiliated.

    • Funding The ARTIS Study Group conducts scientific analyses using data from the Swedish biologics register (ARTIS) run by the Swedish Society for Rheumatology. For this register, the Swedish Society for Rheumatology has received funding, independent of the conduct of these scientific analyses, from Merck, BMS, Pfizer, Abbott Laboratories, SOBI, UCB and Roche. These entities were allowed to comment on the findings before submission, although all final decisions resided with the investigators. This specific study further received funding from the Swedish Medical Research Council, the Swedish Foundation for Strategic Research, and from the Swedish public-private COMBINE research consortium. These entities had no influence on the data collection, statistical analyses, manuscript preparation, or decision to submit.

    • Competing interests None.

    • Ethics approval Obtained from Karolinska Institutet.

    • Provenance and peer review Not commissioned; externally peer reviewed.