{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:55:06Z","timestamp":1790751306824,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated neuropathy that rarely co-occurs with rheumatoid arthritis (RA). When CIDP proves refractory to first-line therapies, management becomes particularly challenging, especially in patients with multiple autoimmune conditions. A 43-year-old Chinese male with a 3-year history of seropositive RA in sustained remission presented with acute progressive quadriparesis, bilateral ptosis, and facial diplegia. Cerebrospinal fluid analysis revealed albuminocytologic dissociation, and nerve conduction studies demonstrated evolving demyelinating features, consistent with a diagnosis of acute-onset CIDP (A-CIDP). The patient responded inadequately to sequential treatment with intravenous immunoglobulin, high-dose corticosteroids, and the neonatal Fc receptor (FcRn) antagonist efgartigimod, experiencing repeated relapses during corticosteroid tapering. Mycophenolate mofetil (MMF) was subsequently introduced as a steroid-sparing agent at 0.75\u00a0g twice daily, enabling further prednisone tapering from 20 mg to 10 mg daily without relapse; MMF was later up-titrated to 1\u00a0g twice daily. Under a combined, multi-target immunosuppressive regimen of MMF, prednisone, methotrexate, iguratimod, and hydroxychloroquine, the patient achieved sustained neurological improvement, with prednisone successfully tapered to 10 mg daily by October 2025 and maintained thereafter. By April 2026, only residual mild ptosis persisted, and no infectious complications occurred. This case suggests that MMF-based multi-target immunosuppression may be a therapeutic option for RA-associated, treatment-refractory A-CIDP, potentially enabling successful glucocorticoid tapering even after an inadequate response to a short course of FcRn-targeted therapy.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1869194","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:00:21Z","timestamp":1790748021000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mycophenolate mofetil as salvage therapy for refractory acute-onset CIDP associated with rheumatoid arthritis: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Jinhui","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, People\u2019s Hospital of Longhua, Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Health Management, People\u2019s Hospital of Longhua, Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linghua","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Health Management, Jiangmen Wuyi Hospital of Chinese Medicine","place":["Jiangmen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, People\u2019s Hospital of Longhua, Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"18001","DOI":"10.1038\/nrdp.2018.1","article-title":"Rheumatoid arthritis","volume":"4","author":"Smolen","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1004965","article-title":"The pathogenesis of rheumatoid arthritis","volume":"365","author":"McInnes","year":"2011","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2017.02.013","article-title":"Lewis-Sumner syndrome in a patient with rheumatoid arthritis: Link between rheumatoid arthritis and demyelinating polyradiculoneuropathies","volume":"84","author":"Kedra","year":"2017","journal-title":"Joint Bone Spine"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.09.018","article-title":"Chronic inflammatory demyelinating polyradiculoneuropathy associated with systemic lupus erythematosus","volume":"51","author":"Julio","year":"2021","journal-title":"Semin Arthritis Rheum"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1159\/000494291","article-title":"Incidence and prevalence of chronic inflammatory demyelinating polyradiculoneuropathy: A systematic review and meta-analysis","volume":"52","author":"Broers","year":"2019","journal-title":"Neuroepidemiology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-309697","article-title":"Chronic inflammatory demyelinating polyradiculoneuropathy: From pathology to phenotype","volume":"86","author":"Mathey","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14959","article-title":"European Academy of Neurology\/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force-second revision","volume":"28","author":"Van den Bergh","year":"2021","journal-title":"Eur J Neurol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2017.84","article-title":"Autoantibodies in chronic inflammatory neuropathies: Diagnostic and therapeutic implications","volume":"13","author":"Querol","year":"2017","journal-title":"Nat Rev Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"Cd001797","DOI":"10.1002\/14651858.CD001797.pub3","article-title":"Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy","volume":"2","author":"Eftimov","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjno-2025-001318","article-title":"Evaluation and treatment of refractory chronic inflammatory demyelinating polyradiculoneuropathy","volume":"7","author":"Kiers","year":"2025","journal-title":"BMJ Neurol Open"},{"key":"B11","doi-asserted-by":"publisher","first-page":"99","DOI":"10.2147\/itt.S388151","article-title":"Chronic inflammatory demyelinating polyradiculoneuropathy: Current therapeutic approaches and future outlooks","volume":"13","author":"Rajabally","year":"2024","journal-title":"Immunotargets Ther"},{"key":"B12","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/ar3175","article-title":"The autoimmune tautology","volume":"12","author":"Anaya","year":"2010","journal-title":"Arthritis Res Ther"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1186\/gm305","article-title":"Emerging patterns of genetic overlap across autoimmune disorders","volume":"4","author":"Richard-Miceli","year":"2012","journal-title":"Genome Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"5783","DOI":"10.1038\/s41598-024-56365-y","article-title":"Clinical characteristics of Guillain-Barr\u00e9 syndrome in patients with primary Sj\u00f6gren's syndrome","volume":"14","author":"Cao","year":"2024","journal-title":"Sci Rep"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s11481-023-10075-w","article-title":"Cyclophosphamide in the treatment of systemic lupus erythematosus-related Guillain-Barr\u00e9 syndrome: A systematic review of case reports","volume":"18","author":"Xiong","year":"2023","journal-title":"J Neuroimmune Pharmacol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e30004","article-title":"Cerebral large vessels vasculitis following Guillain-Barr\u00e9 syndrome as first clinical manifestations of primary Sjogren's syndrome: A case based - review","volume":"10","author":"Saied","year":"2024","journal-title":"Heliyon"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/eji.202250336","article-title":"Expanding our understanding of Guillain-Barr\u00e9 syndrome: Recent advances and clinical implications","volume":"54","author":"Ripellino","year":"2024","journal-title":"Eur J Immunol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(08)70215-1","article-title":"Clinical features, pathogenesis, and treatment of Guillain-Barr\u00e9 syndrome","volume":"7","author":"van Doorn","year":"2008","journal-title":"Lancet Neurol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.14740\/jocmr2550w","article-title":"Systemic lupus erythematosus with acute inflammatory demyelinating polyneuropathy: A case report and review of the literature","volume":"8","author":"Li","year":"2016","journal-title":"J Clin Med Res"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/art.24937","article-title":"Distinct subtypes of myelitis in systemic lupus erythematosus","volume":"60","author":"Birnbaum","year":"2009","journal-title":"Arthritis Rheum"},{"key":"B21","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.ncl.2013.01.005","article-title":"Guillain-Barr\u00e9 syndrome and variants","volume":"31","author":"Dimachkie","year":"2013","journal-title":"Neurol Clin"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s13760-024-02557-2","article-title":"Differentiating recurrent Guillain-Barre syndrome and acute-onset chronic inflammatory polyneuropathy: Literature review","volume":"124","author":"Inan","year":"2024","journal-title":"Acta Neurol Belg"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.121","article-title":"Guillain-Barr\u00e9 syndrome: Pathogenesis, diagnosis, treatment and prognosis","volume":"10","author":"van den Berg","year":"2014","journal-title":"Nat Rev Neurol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s13613-025-01464-w","article-title":"Critical insights for intensivists on Guillain-Barr\u00e9 syndrome","volume":"15","author":"Weiss","year":"2025","journal-title":"Ann Intensive Care"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.yexmp.2024.104942","article-title":"Diagnostic criteria and therapeutic implications of rapid-onset demyelinating polyneuropathies","volume":"140","author":"Ra\u0142owska-Gmoch","year":"2024","journal-title":"Exp Mol Pathol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1038\/nrneurol.2017.123","article-title":"CIDP and other inflammatory neuropathies in diabetes - diagnosis and management","volume":"13","author":"Rajabally","year":"2017","journal-title":"Nat Rev Neurol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"Cd002062","DOI":"10.1002\/14651858.CD002062.pub4","article-title":"Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy","volume":"11","author":"Hughes","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(24)00309-0","article-title":"Safety, tolerability, and efficacy of subcutaneous efgartigimod in patients with chronic inflammatory demyelinating polyradiculoneuropathy (ADHERE): A multicentre, randomised-withdrawal, double-blind, placebo-controlled, phase 2 trial","volume":"23","author":"Allen","year":"2024","journal-title":"Lancet Neurol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(21)00159-9","article-title":"Safety, efficacy, and tolerability of efgartigimod in patients with generalised myasthenia gravis (ADAPT): A multicentre, randomised, placebo-controlled, phase 3 trial","volume":"20","author":"Howard","year":"2021","journal-title":"Lancet Neurol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"76","DOI":"10.3988\/jcn.2025.0247","article-title":"Efficacy, safety, and tolerability of subcutaneous efgartigimod PH20 in Chinese patients with chronic inflammatory demyelinating polyneuropathy: A prespecified subpopulation analysis of the multicentre, randomised-withdrawal, double-blind, placebo-controlled, phase II ADHERE trial","volume":"22","author":"Lin","year":"2026","journal-title":"J Clin Neurol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"14411","DOI":"10.1038\/s41598-017-14853-4","article-title":"Antibodies against peripheral nerve antigens in chronic inflammatory demyelinating polyradiculoneuropathy","volume":"7","author":"Querol","year":"2017","journal-title":"Sci Rep"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awf272","article-title":"Peripheral neuropathies and anti-glycolipid antibodies","volume":"125","author":"Willison","year":"2002","journal-title":"Brain"},{"key":"B33","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/s0162-3109(00)00188-0","article-title":"Mycophenolate mofetil and its mechanisms of action","volume":"47","author":"Allison","year":"2000","journal-title":"Immunopharmacology"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/mus.28436","article-title":"Mycophenolate facilitates improvement in outcome measures in treatment resistant chronic inflammatory demyelinating polyradiculoneuropathy","volume":"72","author":"Miah","year":"2025","journal-title":"Muscle Nerve"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1869194\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:00:22Z","timestamp":1790748022000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1869194\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":34,"alternative-id":["10.3389\/fimmu.2026.1869194"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1869194","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1869194"}}