Neurologische Komplikationen antirheumatischer Pharmakotherapeutika

Zusammenfassung

Hintergrund: Rheumatische Erkrankungen und deren Pharmakotherapie können zu ähnlichen oder identischen Erkrankungen des zentralen und peripheren Nervensystems und der Skelettmuskulatur führen. Die Unterscheidung der beiden Ursachen ist von entscheidender therapeutischer Bedeutung, da im Falle einer Komplikation der Grundkrankheit eventuell eine Therapieeskalation und bei unerwünschter Medikamentennebenwirkung deren Absetzen und häufig eine symptomatische medikamentöse Therapie erforderlich sind.

Methode: Die wichtigsten neurologischen Komplikationen der Pharmakotherapie in der Rheumatologie werden anhand einer Literaturrecherche dargestellt.

Ergebnisse: Die gravierendsten neurologischen Komplikationen sind die meist tödlich verlaufende progressive multifokale Leukoenzephalopathie (Azathioprin, Methotrexat, Cyclosporin, Mycophenolat, Lefunomid, Tumor-Nekrose-Faktor-α-(TNF)-Antagonisten, Rituximab), die posteriore reversible Enzephalopathie (Glukokortikoide, nichtsteroidale Antirheumatika, Azathioprin, Methotrexat, Cyclosporin, Cyclophosphamid, TNF-Antagonisten, Rituximab), andere Enzephalopathien (Sulfasalazin, Cyclosporin), Optikusneuropathien (Cyclosporin, Methotrexat, TNF-Antagonisten), Neuropathien (Dapson, (Hydroxy-)Chloroquin, Cyclosporin, Cyclophosphamid, Leflunomid, TNF-Antagonisten) und Myopathien bzw. Myositiden (Glukokortikoide, (Hydroxy-)Chloroquin. TNF-Antagonisten). Mit Ausnahme der Neuropathien sind diese Komplikationen sehr selten. Weitere gelegentliche ernste Behandlungskomplikationen sind bspw. epileptische Anfälle, motorische und sensible Störungen. Leichtere Komplikationen wie Kopfschmerzen oder Tremor treten häufiger auf.

Schlussfolgerung: Bei der Pharmakotherapie können neu auftretende neurologische Symptome Hinweise auf eine u. U. gravierende Arzneimittelnebenwirkung sein. Sie bedürfen in der Regel rascher weiterer Klärung.

Abstract

Introduction: Rheumatic disorders und their pharmacotherapy may lead to similar or even identical disorders of the central or peripheral nervous system and the skeletal muscles. It is essential to differentiate between both etiologies, since complications of the underlying rheumatic disease may require treatment escalation, whereas complications resulting from adverse effects may make it necessary to discontinue treatment and, in many cases, to start a symptomatic drug treatment.

Method: Based on a literature research, this article presents the most important neurological adverse effects of the pharmacological treatment of rheumatological diseases.

Results: The most severe complications are progressive multifocal leukoencephalopathy, often with a fatal outcome (azathioprine, methotrexate, cyclosporine, mycophenolate, leflunomide, tumour-necrosis factor alpha (TNF)-antagonists, rituximab), posterior reversible encephalopathy (glucocorticoids, non-steroidal antirheumatic drugs, azathioprine, methotrexate, cyclosporine, cyclophosphamide, tumour-necrosis alpha (TNF)-antagonists, rituximab), other encephalopathies (sulfasalazine, cyclosporine), optic neuropathies (cyclosporine, methotrexate, TNF-antagonists), neuropathies (dapsone, (hydroxy-) chloroquine, cyclosporine, leflunomide, TNF-antagonists), and myopathies or myositides (glucocorticoids, (hydroxy-)chloroquine, TNF-antagonists). Except for the neuropathies these complications are very rare. Further serious treatment complications are, for instance, epileptic seizures, motor and sensory disturbances. Milder complications such as headaches or tremor occur more frequently.

Conclusion: New neurological signs and symptoms occurring with rheumatological pharmacotherapy may be hints for severe adverse effects. They usually require prompt neurological evaluation.

Schlüsselwörter

neurologische Komplikationen - Pharmakotherapie - Biologika - Neuropathien - Enzephalopathien

Key words

neurological complications - pharmacotherapy - immunobiologics - neuropathies - encephalopathies

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