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Multiple sclerosis (MS) is a chronic inflammatory neurological disease with multifactorial aetiology.1 Evidence of tumour necrosis factor (TNF)-α as an important factor in the pathogenesis of MS has emerged.2 However, attempts of treating MS with TNF-inhibitors (TNFi) have increased disease activity.3 Several case reports have indicated that demyelinating diseases could be a serious adverse event following TNFi treatment while data from the Spanish Registry of biological therapies in rheumatic diseases did not bring clarification.4 ,5 Some, but not all, studies have suggested a negative association between rheumatoid arthritis (RA) and MS.6 ,7
We aimed to investigate whether TNFi treatment in patients with arthritis is associated with an increased risk of developing MS and whether RA is associated with a decreased risk compared with the general population.
The nationwide Danish DANBIO Registry started in 2000 and covers >90% of adults with rheumatological disease treated with TNFi in routine care.8 Since 2005, patients not treated with …