Entzündlich-rheumatische Erkrankungen und neurologische Manifestationen

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.
• 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.
• 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.
• 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.
• 5 Sharma BK, Jain S, Suri S, Numano F. Diagnostic criteria for Takayasu arteritis. International journal of cardiology 1996; 54 (Suppl): S141-S147.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 29 Farinha F, Abrol E, Isenberg DA. Biologic therapies in patients with neuropsychiatric systemic lupus erythematosus. Lupus 2016; 25 (11) 1278-1279.
• 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.
• 31 Teixeira F, Moreira I, Silva AM. et al. Neurological involvement in Primary Sjogren Syndrome. Acta Reumatol Port 2013; 38 (01) 29-36.
• 32 Collins MP. The vasculitic neuropathies: an update. Curr Opin Neurol 2012; 25 (05) 573-585.
• 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.
• 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.
• 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.
• 36 Naddaf E, Dyck PJ. Vasculitic Neuropathies. Curr Treat Options Neurol 2015; 17 (10) 374.
• 37 Jennette JC. et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65 (01) 1-11.