Combination of Secukinumab and Natalizumab in the Treatment of a Patient with Psoriatic Arthritis and Multiple Sclerosis

Case Presentation: A woman with recurrent episodes of uveitis, polyarthritis and enthesitis, besides a history of sacroiliitis, a skin biopsy with psoriasiform chronic dermatitis and a familiar history of a son with psoriasis, was diagnosed with psoriatic arthritis. After receiving methotrexate and azathioprine without a satisfactory response, she began treatment with adalimumab. She had a demyelinating episode while receiving this treatment, leading to the diagnosis of very active multiple sclerosis. Adalimumab was discontinued and treatment with secukinumab, natalizumab and sulfasalazine was started. Since then, she had an improvement in arthralgias and low back pain, without any major adverse events described until today. She also did not have any new attacks during this period. She has been receiving natalizumab for a year and a half and secukinumab for half a year now. Discussion: The association of psoriatic arthritis with multiple sclerosis is rare. In this case, the use of anti-TNF may have been a trigger for the manifestation of a demyelinating disease. Because of the risk of having new demyelinating episodes, this medication is contraindicated for this patient. The absence of a single drug that could appropriately treat both conditions brings the need for a combined therapy, increasing the risk of adverse effects and testing the efficacy of these drugs when used together. Until now, the combination of secukinumab and natalizumab has been shown to be safe and effective. Final Comments: Considering that finding patients in these same circumstances is infrequent, conducting controlled randomized trials may be extremely difficult. Therefore, case reports like this one can be helpful for clinical practice. Monitoring this patient for a longer time might help establish with greater accuracy the safety and effectiveness of this combined therapy, which may also be useful in other clinical contexts.