Aktuelle Rheumatologie 2001; 26(6): 285-290
DOI: 10.1055/s-2001-19065
RHEUMATOLOGIE UND NEUROLOGIE
© Georg Thieme Verlag Stuttgart · New York

Neurologische Komplikationen der Therapie rheumatischer Erkrankungen

Neurologic Complications of Therapy in Rheumatic DiseasesC. A. Böger, H. Kellner
  • Rheuma-Einheit (Leiter: Prof. Dr. med. M. Schattenkirchner), Medizinische Poliklinik, Klinikum der Universität, Innenstadt, München
Further Information

Publication History

Publication Date:
17 December 2001 (online)

Zusammenfassung

Die Therapie der meisten entzündlich rheumatischen Erkrankungen beinhaltet grundsätzlich mindestens eines der zahlreichen Basistherapeutika (krankheitsmodifizierende Therapie). Je nach Krankheitsaktivität erfolgt die additive Gabe von Glukokortikoiden, nicht-steroidalen Antirheumatika (NSAR) und Analgetika. Neben dem belegten therapeutischen Nutzen der jeweiligen Therapien besteht ein signifikantes Nebenwirkungspotenzial bei sämtlichen Substanzen. In dieser Übersicht werden die neurologischen Nebenwirkungen beleuchtet und Vorschläge zu deren Prävention und Therapie gemacht.

Neurologic Complications of Therapy in Rheumatic Diseases

The therapy of most inflammatory rheumatic diseases comprises at least one disease-modifying anti-rheumatic drug (DMARD). Depending on the disease activity, additional therapy with corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics is performed. Unfortunately, there is a significant profile of adverse effects of each of these substance groups, frequently leading to discontinuation of therapy. In this review, the adverse neurological effects of the antirheumatic agents are reviewed and recommendations for their prevention and treatment are made.

Literatur

  • 1 Amos R S, Pullar T, Bax D E, Situnayake D, Capell H A, McConkey B. Sulphasalazine for rheumatoid arthritis: toxicity in 774 patients monitored for one to 11 years.  Br Med J (Clin Res Ed). 1986;  293 420-423
  • 2 Avina-Zubieta J A, Johnson E S, Suarez-Almazor M E, Russell A S. Incidence of myopathy in patients treated with antimalarials. A report of three cases and a review of the literature.  Br J Rheumatol. 1995;  34 166-170
  • 3 Bernstein H N. Ocular safety of hydroxychloroquine.  Ann Ophthalmol. 1991;  23 292-295
  • 4 Black A J, McLeod H L, Capell H A, Powrie R H, Matowe L K, Pritchard S C, Collie-Duguid E S, Reid D M. Thiopurine methyltransferase genotype predicts therapy-limiting severe toxicity from azathioprine.  Ann Intern Med. 1998;  129 716-718
  • 5 Boonen S, Van Distel G, Westhovens R, Dequeker J. Steroid myopathy induced by epidural triamcinolone injection.  Br J Rheumatol. 1995;  34 385-386
  • 6 Box S A, Pullar T. Sulphasalazine in the treatment of rheumatoid arthritis.  Br J Rheumatol. 1997;  36 382-386
  • 7 Canadian rheumatology association . Canadian Consensus Conference on hydroxychloroquine.  J Rheumatol. 2000;  27 2919-2921
  • 8 Easterbrook M. Ocular effects and safety of antimalarial agents.  Am J Med. 1988;  85 23-29
  • 9 Eidelman B H, Abu-Elmagd K, Wilson J, Fung J J, Alessiani M, Jain A, Takaya S, Todo S N, Tzakis A, Van Thiel D et al. Neurologic complications of FK 506.  Transplant Proc. 1991;  23 3175-3178
  • 10 Estes M L, Ewing-Wilson D, Chou S M, Mitsumoto H, Hanson M, Shirey E, Ratliff N B. Chloroquine neuromyotoxicity. Clinical and pathologic perspective.  Am J Med. 1987;  82 447-455
  • 11 European FK506 Multicentre Liver Study Group . Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection.  Lancet. 1994;  344 423-428
  • 12 Fam A G, Gordon D a, Sarkozi J, Blair G R, Cooper P W, Harth M, Lewis A J. Neurologic complications associated with gold therapy for rheumatoid arthritis.  J Rheumatol. 1984;  11 700-706
  • 13 Felson D T, Anderson J J, Meenan R F. The efficacy and toxicity of combination therapy in rheumatoid arthritis. Results of two meta-analyses.  Arthritis Rheum. 1994;  37 1487-1491
  • 14 Hoppmann R A, Peden J G, Ober S K. Central nervous system side effects of nonsteroidal anti-inflammatory drugs. Aseptic meningitis, psychosis, and cognitive dysfunction.  Arch Intern Med. 1991;  151 1309-1313
  • 15 Howard-Lock H E, Lock C JC, Mewz A, Kean W F. D-Penicillamine: chemistry and clinical use in rheumatic disease.  Sem Arthritis Rheum. 1986;  15 261-281
  • 16 Keenan P A, Jacobson M W, Soleymani R M, Mayes M D, Stress M E, Yaldoo D T. The effect on memory of chronic prednisone treatment in patients with systemic disease.  Neurology. 1996;  47 1396-1402
  • 17 Kerschner P, Wang-Cheng R. Psychiatric side effects of steroid therapy.  Psychosomatics. 1989;  30 135
  • 18 Kremer J M, Phelps C T. Long-term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis.  Arthritis Rheum. 1992;  35 138-145
  • 19 Lange A E, Humphrey J G. Plasma exchange treatment for severe penicillamine induced myasthenia gravis.  J Rheumatol. 1981;  8 169
  • 20 Maini R, St Clair E W, Breedveld F, Furst D, Kalden J, Weisman M, Smolen J, Emery P, Harriman G, Feldmann M, Lipsky P et al. Infliximab (chimeric antitumor necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trialSM. ATTRACT Study Group.  Lancet. 1999;  354 1932-1939
  • 21 Middleton G D, McFarlin J E, Lipsky P E. Hydroxychloroquine and pain thresholds.  Arthritis Rheum. 1995;  38 445-447
  • 22 Mohan N, Edwards E T, Cupps T R, Oliverio P J, Siegel J N. Demyelination diagnosed during etanercept therapy.  Arthritis Rheum. 2000;  43 970
  • 23 Morgan S L, Baggott J E, Vaughn W H, Austin J S, Veitch T A, Lee J Y, Koopman W J, Krumdieck C L, Alarcon G S. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial.  Ann Intern Med. 1994;  121 833-841
  • 24 Naber D, Sand P, Heigl B. Psychopathological and neuropsychological effects of 8-days’ corticosteroid treatment. A prospective study.  Psychoneuroendocrinology. 1996;  21 25-31
  • 25 Ortiz Z, Shea B, Suarez-Almazor M E, Moher D, Wells G A, Tugwell P. The efficacy of folic acid and folinic acid in reducing methotrexate gastrointestinal toxicity in rheumatoid arthritis. A metaanalysis of randomized controlled trials.  J Rheumatol. 1998;  25 36-43
  • 26 Quinn C T, Kamen B A. A biochemical perspective of methotrexate neurotoxicity with insight on nonfolate rescue modalities.  J Investig Med. 1996;  44 522-530
  • 27 Rau R. Methotrexat.  In: Basistherapie der rheumatoiden Arthritis. 1. Auflage. Uni-Med Verlag 2000: 192
  • 28 Schattenkirchner M, Krüger K, Sander O et al. Efficacy and tolerability of weekly subcutaneous injections of the fully human anti-TNF antibody D2E7 in patients with rheumatoid arthritis.  Arthritis Rheum. 1998;  41 57
  • 29 Serre H et al. Syndrome de Guillain-Barré après chrysotherapie.  Rheumatol. 1975;  27 467
  • 30 Simon L S, Mills J A. Drug therapy: nonsteroidal antiinflammatory drugs (first of two parts).  N Engl J Med. 1980;  302 1179-1185
  • 31 Taylor H G, Samanta A. Penicillamine in rheumatoid arthritis.  Drug Saf. 1992;  7 46-53
  • 32 van Oosten B W, Barkhof F, Truyen L, Boringa J B, Bertelsmann F W, von Blomberg B M, Woody J N, Hartung H P, Polman C H. Increased MRI activity and immune activation in two multiple sclerosis patients treated with the monoclonal anti-tumor necrosis factor antibody cA2.  Neurology. 1996;  47 1531-1534
  • 33 Weinblatt M E, Kaplan H, Germain B F. Methotrexate in rheumatoid arthritis: effects on disease activity in a multicenter prospective study.  J Rheumatol. 1991;  18 334-338
  • 34 Weinblatt M E, Maier A L, Fraser P A, Coblyn J S. Longterm prospective study of methotrexate in rheumatoid arthritis: conclusion after 132 months of therapy.  J Rheumatol. 1998;  25 238-242
  • 35 Weinstein G D, Roenigk H, Maibach H I. Psoriasis liver methotrexate interactions.  Arch Dermatol. 1973;  108 36
  • 36 Wijdicks E F, Wiesner R H, Krom R A. Neurotoxicity in liver transplant recipients with cyclosporine immunosuppression.  Neurology. 1995;  45 1962-1964
  • 37 Wooley P H, Griffin J, Panayi G S, Patchelor J R, Welsh K I, Gibson T J. HLA-DR antigens and toxic reaction to sodium aurothiomalate and D-penicillamine in patients with rheumatoid arthritis.  N Engl J Med. 1980;  303 300-302

Dr. med. C. Böger

Rheuma-Einheit, Medizinische Poliklinik
Klinikum der Universität, Innenstadt

Pettenkoferstraße 8a
80336 München

Email: carsten.boeger@gmx.net

    >