Download PDF
Arthritis und Rheuma 2018; 38(01): 27-33
DOI: 10.1055/s-0038-1636988
Organbeteiligung bei Rheuma
Schattauer GmbH

Entzündlich-rheumatische Erkrankungen und neurologische Manifestationen

Neurological involvement in inflammatory rheumatological diseases
J. Röther
1   Kopfund Neurozentrum, Neurologische Abteilung mit überregionaler Stroke Unit, Neurophysiologie und Neurologischer Intensivmedizin, Asklepios Klinik Altona
,
A. Bickel
1   Kopfund Neurozentrum, Neurologische Abteilung mit überregionaler Stroke Unit, Neurophysiologie und Neurologischer Intensivmedizin, Asklepios Klinik Altona
,
I. Kötter
2   Rheumatologie, klinische Immunologie, Nephrologie, Asklepios Klinik Altona
› Author Affiliations
Further Information

Publication History

Publication Date:
04 April 2018 (online)

    Permissions and Reprints

Zusammenfassung

Entzündliche Erkrankungen des peripheren und zentralen Nervensystems sind oft eine Herausforderung, und regelmäßig stellt sich die Frage nach einer entzündlich-rheumatischen Grunderkrankung. Die Erstdiagnose einer Vaskulitis oder einer Kollagenose erfolgt sowohl in der Neurologie als auch in der Rheumatologie und daher benötigen Rheumatologen neurologisches Symptomwissen und Neurologen ein Verständnis der entzündlich-rheumatischen Krankheitszeichen. Die diagnostische Zuordnung kann eindeutig sein, wenn typische Symptomkonstellationen vorhanden und diagnostische Kriterien seitens der zerebralen Bildgebung und der Labordiagnostik passend sind. Häufig ist aber der Nachweis einer entzündlich-rheumatologischen Erkrankung erschwert, und eine enge Kooperation zwischen dem neurologischen und rheumatologischen Fachgebiet ist sinnvoll. Wir geben nachfolgend eine Übersicht über die häufigsten neurologischen Manifestationen entzündlich-rheumatologischer Erkrankungen und deren moderne Therapieoptionen.

Summary

Inflammatory diseases of the peripheral and central nervous system (CNS) are challenging and whenever other organs besides the CNS are involved, a rheumatological disease needs to be considered. When a patient presents with seizures, focal deficits, encephalopathy and multifocal ischemic MRI lesions, a secondary CNS involvement by small-medium-sized or large-vessel vasculitis is possible and needs further diagnostic work-up. Diagnosis may be difficult and not all patients present with typical imaging or laboratory patterns. Cooperation between the departments of Neurology and Rheumatology is therefore important for an optimal management. Besides the acute therapy with glucocorticoids, immunosuppressive agents are usually applied for long term therapy. In refractory cases, biologicals play an important role.

Schlüsselwörter

Vaskulitis - zentrales Nervensystem - peripheres Nervensystem - Polyneuropathie - Neuro-Behçet - Riesenzellarteriitis

Keywords

Vasculitis - central nervous system - peripheral nervous system - polyneuropathy - neuro-Behcet - giant cell arteriitis
 

  • Literatur

  • 1 Meini S, De Franco V, Auteri A, Pieragalli D. Images in cardiovascular medicine. Takayasu’s arteritis: the “macaroni sign”. Circulation 2006; 114 (16) e544.
    PubMedGoogle Scholar
  • 2 Loffler C, Hoffend J, Benck U. et al. The value of ultrasound in diagnosing extracranial large-vessel vasculitis compared to FDG-PET/CT: A retrospective study. Clinical rheumatology 2017; 36 (09) 2079-2086.
    CrossrefPubMedGoogle Scholar
  • 3 Zhu FP, Luo S, Wang ZJ. et al. Takayasu arteritis: imaging spectrum at multidetector CT angiography. Br J Radiol 2012; 85 (1020): e1282-e1292.
    CrossrefPubMedGoogle Scholar
  • 4 Bond KM, Nasr D, Lehman V. et al. Intracranial and Extracranial Neurovascular Manifestations of Takayasu Arteritis. AJNR American journal of neuroradiology 2017; 38 (04) 766-772.
    CrossrefPubMedGoogle Scholar
  • 5 Sharma BK, Jain S, Suri S, Numano F. Diagnostic criteria for Takayasu arteritis. International journal of cardiology 1996; 54 (Suppl): S141-S147.
    CrossrefPubMedGoogle Scholar
  • 6 Samson M, Espigol-Frigole G, Terrades-Garcia N. et al. Biological treatments in giant cell arteritis & Takayasu arteritis. Eur J Intern Med. 2017 Nov 13.
    PubMedGoogle Scholar
  • 7 Nakaoka Y, Isobe M, Takei S. et al. Efficacy and safety of tocilizumab in patients with refractory Takayasu arteritis: results from a randomised, double-blind, placebo-controlled, phase 3 trial in Japan (the TAKT study). Annals of the rheumatic diseases. 2017 Nov 30.
    PubMedGoogle Scholar
  • 8 Samson M, Jacquin A, Audia S. et al. Stroke associated with giant cell arteritis: a population-based study. J Neurol Neurosurg Psychiatry 2015; 86 (02) 216-221.
    CrossrefPubMedGoogle Scholar
  • 9 Aschwanden M, Daikeler T, Kesten F. et al. Temporal artery compression sign - a novel ultrasound finding for the diagnosis of giant cell arteritis. Ultraschall Med 2013; 34 (01) 47-50.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Loricera J, Blanco R, Hernandez JL. et al. Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients. Seminars in arthritis and rheumatism 2015; 44 (06) 717-723.
    CrossrefPubMedGoogle Scholar
  • 11 Choi HA, Lee MJ, Chung CS. Characteristics of hypertrophic pachymeningitis in patients with granulomatosis with polyangiitis. Journal of neurology 2017; 264 (04) 724-732.
    CrossrefPubMedGoogle Scholar
  • 12 De Luna G, Terrier B, Kaminsky P. et al. Central nervous system involvement of granulomatosis with polyangiitis: clinical-radiological presentation distinguishes different outcomes. Rheumatology 2015; 54 (03) 424-432.
    CrossrefPubMedGoogle Scholar
  • 13 Yates M, Watts RA, Bajema IM. et al. EULAR/ERAEDTA recommendations for the management of ANCA-associated vasculitis. Annals of the rheumatic diseases 2016; 75 (09) 1583-1594.
    PubMedGoogle Scholar
  • 14 Schirmer JH, Aries PM, de Groot K. et al. [S1 guidelines Diagnostics and treatment of ANCAassociated vasculitis]. Zeitschrift fur Rheumatologie 2017; 76 (Suppl. 03) 77-104.
    CrossrefPubMedGoogle Scholar
  • 15 Andre R, Cottin V, Saraux JL. et al. Central nervous system involvement in eosinophilic granulomatosis with polyangiitis (Churg-Strauss): Report of 26 patients and review of the literature. Autoimmun Rev 2017; 16 (09) 963-969.
    CrossrefPubMedGoogle Scholar
  • 16 Wechsler ME, Akuthota P, Jayne D. et al. Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis. The New England journal of medicine. [Clinical Trial, Phase III Comparative Study Multicenter Study Randomized Controlled Trial] 2017; 376 (20) 1921-1832.
    CrossrefPubMedGoogle Scholar
  • 17 Yamashiro K, Mori A, Shimada Y. et al. Gradient echo T2*-weighted magnetic resonance imaging revealing cerebral microbleeds in a patient with microscopic polyangiitis complicated by cerebrovascular disease. J Stroke Cerebrovasc Dis 2012; 21 (08) 904 e7-9.
    Google Scholar
  • 18 The International Criteria for Behcet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 2014; 28 (03) 338-347.
    CrossrefPubMedGoogle Scholar
  • 19 Hatemi G, Silman A, Bang D. et al. EULAR recommendations for the management of Behcet disease. Annals of the rheumatic diseases 2008; 67 (12) 1656-1662.
    CrossrefPubMedGoogle Scholar
  • 20 Petri M, Orbai AM, Alarcon GS. et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis and rheumatism 2012; 64 (08) 2677-2686.
    CrossrefPubMedGoogle Scholar
  • 21 Kakati S, Barman B, Ahmed SU, Hussain M. Neurological Manifestations in Systemic Lupus Erythematosus: A Single Centre Study from North East India. J Clin Diagn Res. 2017; 11 (01) OC05-OC9.
    PubMedGoogle Scholar
  • 22 Cohen D, Rijnink EC, Nabuurs RJ. et al. Brain histopathology in patients with systemic lupus erythematosus: identification of lesions associated with clinical neuropsychiatric lupus syndromes and the role of complement. Rheumatology 2017; 56 (01) 77-86.
    CrossrefPubMedGoogle Scholar
  • 23 Abe G, Kikuchi H, Arinuma Y, Hirohata S. Brain MRI in patients with acute confusional state of diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus. Modern rheumatology 2017; 27 (02) 278-283.
    CrossrefPubMedGoogle Scholar
  • 24 de Amorim LC, Maia FM, Rodrigues CE. Stroke in systemic lupus erythematosus and antiphospholipid syndrome: risk factors, clinical manifestations, neuroimaging, and treatment. Lupus 2017; 26 (05) 529-536.
    CrossrefPubMedGoogle Scholar
  • 25 Ruiz-Irastorza G, Khamashta MA, Hughes GR. Antiaggregant and anticoagulant therapy in systemic lupus erythematosus and Hughes’ syndrome. Lupus 2001; 10 (03) 241-245.
    CrossrefPubMedGoogle Scholar
  • 26 Kaichi Y, Kakeda S, Moriya J. et al. Brain MR findings in patients with systemic lupus erythematosus with and without antiphospholipid antibody syndrome. AJNR American journal of neuroradiology 2014; 35 (01) 100-105.
    CrossrefPubMedGoogle Scholar
  • 27 Bertsias GK, Ioannidis JP, Aringer M. et al. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Annals of the rheumatic diseases 2010; 69 (12) 2074-2082.
    CrossrefPubMedGoogle Scholar
  • 28 Tony HP, Burmester G, Schulze-Koops H. et al. Safety and clinical outcomes of rituximab therapy in patients with different autoimmune diseases: experience from a national registry (GRAID). Arthritis research & therapy 2011; 13 (03) R75.
    CrossrefPubMedGoogle Scholar
  • 29 Farinha F, Abrol E, Isenberg DA. Biologic therapies in patients with neuropsychiatric systemic lupus erythematosus. Lupus 2016; 25 (11) 1278-1279.
    CrossrefPubMedGoogle Scholar
  • 30 Shiboski CH, Shiboski SC, Seror R. et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjogren’s syndrome: A consensus and data-driven methodology involving three international patient cohorts. Annals of the rheumatic diseases 2017; 76 (01) 9-16.
    CrossrefPubMedGoogle Scholar
  • 31 Teixeira F, Moreira I, Silva AM. et al. Neurological involvement in Primary Sjogren Syndrome. Acta Reumatol Port 2013; 38 (01) 29-36.
    PubMedGoogle Scholar
  • 32 Collins MP. The vasculitic neuropathies: an update. Curr Opin Neurol 2012; 25 (05) 573-585.
    CrossrefPubMedGoogle Scholar
  • 33 Wolf J, Schmitt V, Palm F. et al. Peripheral neuropathy as initial manifestation of primary systemic vasculitides. Journal of neurology 2013; 260 (04) 1061-1070.
    CrossrefPubMedGoogle Scholar
  • 34 Mori K, Iijima M, Koike H. et al. The wide spectrum of clinical manifestations in Sjogren’s syndrome-associated neuropathy. Brain 2005; Nov; 128 (Pt 11): 2518-2534.
    PubMedGoogle Scholar
  • 35 Vital C, Vital A, Canron MH. et al. Combined nerve and muscle biopsy in the diagnosis of vasculitic neuropathy. A 16-year retrospective study of 202 cases. J Peripher Nerv Syst 2006; 11 (01) 20-29.
    PubMedGoogle Scholar
  • 36 Naddaf E, Dyck PJ. Vasculitic Neuropathies. Curr Treat Options Neurol 2015; 17 (10) 374.
    PubMedGoogle Scholar
  • 37 Jennette JC. et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65 (01) 1-11.
    CrossrefPubMedGoogle Scholar