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The report by Hoffmann et al.1 raises an interesting issue regarding the association between tumor necrosis factor (TNF) and CNS demyelinating disease. This case report is pertinent in light of the failure of TNF-alpha antagonists to reduce relapses and inflammation in relapsing remitting multiple sclerosis (MS).2
TNF receptor associated periodic syndrome (TRAPS) belongs to a family of noninfectious inflammatory disorders characterized by repeated bouts of fever, abdominal pain, and joint swelling due to synovial inflammation, without evidence of systemic autoimmunity.3 In addition, there have been case reports of patients with TRAPS who present with neurologic symptoms and abnormalities on MR imaging of the brain (CNS-TRAPS).4 Patients with TRAPS have mutations in the extracellular domain of the TNF receptor 1 (TNFR1) gene and at least 46 different mutations have been described. In normal circumstances, TNFR1 is shed from the receptors on the cell surface, leading to a pool of …
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