Download PDF
Fortschr Neurol Psychiatr 2002; 70(12): 663-677
DOI: 10.1055/s-2002-35855
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Zerebrale Vaskulitis

Cerebral VasculitisP.  Berlit1 , A.  Steinbrecher2
  • 1Neurologische Klinik Alfried Krupp Krankenhaus Essen
  • 2Neurologische Universitätsklinik Regensburg
Auszüge der vorliegenden Arbeit wurden verwendet für die Erstellung der Leitlinie „Vaskulitis” der Deutschen Gesellschaft für Neurologie
Further Information

Publication History

Publication Date:
02 December 2002 (online)

    Permissions and Reprints

Zusammenfassung

In dieser Übersicht werden die isolierte ZNS-Vaskulitis, die zerebrale Beteiligung bei systemischen Vaskulitiden und Kollagenosen auf neuestem Stand dargestellt. ZNS-Vaskulitiden zeigen sich mit der Kombination von Kopfschmerzen, multifokalen Ausfällen und Enzephalopathie. In der Diagnostik sind MRT, digitale Subtraktionsangiographie, Liquor- und Serumbefunde hilfreich. Laborchemische und neuroradiologische Befunde sind aber letztlich unspezifisch - sie können die Verdachtsdiagnose einer Vaskulitis nie beweisen; mit Ausnahme des Behçet-Syndroms gilt für alle Vaskulitiden und Kollagenosen, dass die Diagnose bioptisch abgesichert werden muss, bevor eine immunsuppressive Therapie eingeleitet wird. Therapie der Wahl ist zumeist die kombinierte Gabe von Kortikosteroiden und Cyclophosphamid.

Abstract

This review focuses on isolated CNS-angiitis and cerebral involvement in systemic vasculitides and collagen vascular diseases. CNS-vasculitis presents with headache, multifocal symptoms, and encephalopathy, respectively. Clinical diagnosis is based on MRI, angiography and both CSF and serum examinations. But neither laboratory nor neuroradiological findings are specific - in all vasculitides with the exception of the Behçet-syndrome a biopsy is necessary before immunosuppressive treatment is started. Therapy of choice is the combination of corticosteroids and cyclophosphamide.

Literatur

  • 1 Padovan C S, Bise K, Hahn J. et al . Angiitis of the central nervous system after allogeneic bone marrow transplantation?.  Stroke. 1999;  30 1651-1656
    CrossrefPubMedGoogle Scholar
  • 2 Schmidley J W. Central nervous system angiitis. Boston: Butterworth-Heinemann 2000
    Google Scholar
  • 3 Biller J, Loftus C M, Moore S A, Schelper R L, Danks K R, Cornell S H. Isolated central nervous system angiitis first presenting as spontaneous intracranial hemorrhage.  Neurosurgery. 1987;  20 310-315
    PubMedGoogle Scholar
  • 4 Calabrese L H, Mallek J A. Primary angiitis of the central nervous system. Report of 8 new cases, review of the literature, and proposal for diagnostic criteria.  Medicine (Baltimore). 1988;  67 20-39
    CrossrefPubMedGoogle Scholar
  • 5 Hankey G J. Isolated angiitis/angiopathy of the central nervous system.  Cerebrovasc Dis. 1991;  1 2-15
    PubMedGoogle Scholar
  • 6 Younger D S, Hays A P, Brust J C, Rowland L P. Granulomatous angiitis of the brain. An inflammatory reaction of diverse etiology.  Arch Neurol. 1988;  45 514-518
    PubMedGoogle Scholar
  • 7 Calabrese L H, Furlan A J, Gragg L A, Ropos T J. Primary angiitis of the central nervous system: diagnostic criteria and clinical approach.  Cleve Clin J Med. 1992;  59 293-306
    CrossrefPubMedGoogle Scholar
  • 8 Vollmer T L, Guarnaccia J, Harrington W, Pacia S V, Petroff O A. Idiopathic granulomatous angiitis of the central nervous system. Diagnostic challenges.  Arch Neurol. 1993;  50 925-930
    CrossrefPubMedGoogle Scholar
  • 9 Stone J H, Pomper M G, Roubenoff R, Miller T J, Hellmann D B. Sensitivities of noninvasive tests for central nervous system vasculitis: a comparison of lumbar puncture, computed tomography, and magnetic resonance imaging.  J Rheumatol. 1994;  21 1277-1282
    PubMedGoogle Scholar
  • 10 Pomper M G, Miller T J, Stone J H, Tidmore W C, Hellmann D B. CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography.  Am J Neuroradiol. 1999;  20 75-85
    PubMedGoogle Scholar
  • 11 Alrawi A, Trobe J D, Blaivas M, Musch D C. Brain biopsy in primary angiitis of the central nervous system.  Neurology. 1999;  53 858-860
    CrossrefPubMedGoogle Scholar
  • 12 Chu C T, Gray L, Goldstein L B, Hulette C M. Diagnosis of intracranial vasculitis: a multi-disciplinary approach.  J Neuropathol Exp Neurol. 1998;  57 30-38
    CrossrefPubMedGoogle Scholar
  • 13 Duna G F, Calabrese L H. Limitations of invasive modalities in the diagnosis of primary angiitis of the central nervous system.  J Rheumatol. 1995;  22 662-667
    PubMedGoogle Scholar
  • 14 Parisi J E, Moore P M. The role of biopsy in vasculitis of the central nervous system.  Semin Neurol. 1994;  14 341-348
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Moore P M. Diagnosis and management of isolated angiitis of the central nervous system.  Neurology. 1989;  39 167-173
    CrossrefPubMedGoogle Scholar
  • 16 Berlit P. The spectrum of vasculopathies in the differential diagnosis of vasculitis.  Sem Neurol. 1994;  14 370-379
    PubMedGoogle Scholar
  • 17 Calabrese L H, Gragg L A, Furlan A J. Benign angiopathy. A distinct subset of angiographically defined primary angiitis of the CNS.  J Rheumatol. 1993;  20 2046-2050
    PubMedGoogle Scholar
  • 18 Woolfenden A R, Tong D C, Marks M P. et al . Angiographically defined primary angiitis of the CNS: Is it really benign?.  Neurology. 1998;  51 183-188
    PubMedGoogle Scholar
  • 19 Berlit P. Vaskulitis. In: Hamann-Siebler-von Scheidt (eds) Schlaganfall. Landsberg: Ecomed 2002
    Google Scholar
  • 20 Caselli R J, Hunder G G. Giant cell (temporal) arteritis.  Neurol Clin. 1997;  15 893-902
    CrossrefPubMedGoogle Scholar
  • 21 Levine S M, Hellmann D B. Giant cell arteritis.  Curr Opin Rheumatol. 2002;  14 3-10
    CrossrefPubMedGoogle Scholar
  • 22 Berlit P. Giant Cell Arteritis. In: Lechtenberg R, Schutta HS (eds). Practice Guidelines for Neurologic Therapy. New York: Marcel Dekker 1997
    Google Scholar
  • 23 Schmidt W A, Kraft H E, Vorpahl K, Völker L, Gromnica-Ihle E J. Color duplex ultrasonography in the diagnosis of temporal arteritis.  N Engl J Med. 1997;  337 1336-1342
    CrossrefPubMedGoogle Scholar
  • 24 De Silva M, Hazleman B L. Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study.  Ann Rheum Dis. 1986;  45 136-138
    CrossrefPubMedGoogle Scholar
  • 25 Spiera R F, Mitnick H J, Kupersmith M, Richmond M, Spiera H, Peterson M G. et al . A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA).  Clin Exp Rheumatol. 2001;  19 495-501
    PubMedGoogle Scholar
  • 26 Liozon F, Vidal E, Gaches F, Venot J, Liozon E, Cransac M, Loustaud V, Berdah J F. Death in Horton disease. Prognostic factors.  Rev Med Interne. 1992;  13 187-191
    PubMedGoogle Scholar
  • 27 Caselli R J, Hunder G G. Neurologic aspects of giant cell (temporal) arteritis.  Rheum Dis Clin North-Am. 1993;  19 941-953
    PubMedGoogle Scholar
  • 28 Hoffman G S, Leavitt R Y, Kerr G S, Rottem M, Sneller M C, Fauci A S. Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate.  Arthritis Rheum. 1994;  37 578-582
    CrossrefPubMedGoogle Scholar
  • 29 Shelhamer J H, Volkman D J, Parrillo J E, Lawley T J, Johnston M R, Fauci A S. Takayasu's arteritis and its therapy.  Ann Intern Med. 1985;  103 121-126
    CrossrefPubMedGoogle Scholar
  • 30 Jennette J C, Falk R J, Andrassy K, Bacon P A, Churg J, Gross W L, Hagen E C, Hoffmann G S, Hunder G G, Kallenberg C G. et al . Nomenclature of systemic vasculitides. Proposal of an international consensus conference.  Arthritis-Rheum. 1994;  37 187-192
    CrossrefPubMedGoogle Scholar
  • 31 Watts R A, Jolliffe V A, Carruthers D M, Lockwood M, Scott D G. Effect of classification on the incidence of polyarteritis nodosa and microscopic polyangiitis.  Arthritis Rheum. 1996;  39 1208-1212
    PubMedGoogle Scholar
  • 32 Vassilopoulos D, Calabrese L H. Hepatitis C virus infection and vasculitis: implications of antiviral and immunosuppressive therapies.  Arthritis Rheum. 2002;  46 585-597
    CrossrefPubMedGoogle Scholar
  • 33 Langford C A. Treatment of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: where do we stand?.  Arthritis Rheum. 2001;  44 508-512
    CrossrefPubMedGoogle Scholar
  • 34 Gayraud M, Guillevin L, Toumelin P, Cohen P, Lhote F, Casassus P. et al . Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients.  Arthritis Rheum. 2001;  44 666-675
    CrossrefPubMedGoogle Scholar
  • 35 Gayraud M, Guillevin L, Cohen P, Lhote F, Cacoub P, Deblois P. et al . Treatment of good-prognosis polyarteritis nodosa and Churg-Strauss syndrome: comparison of steroids and oral or pulse cyclophosphamide in 25 patients. French Cooperative Study Group for Vasculitides.  Br J Rheumatol. 1997;  36 1290-1297
    CrossrefPubMedGoogle Scholar
  • 36 Haubitz M, Schellong S, Gobel U, Schurek H J, Schaumann D, Koch K M. et al . Intravenous pulse administration of cyclophosphamide versus daily oral treatment in patients with antineutrophil cytoplasmic antibody- associated vasculitis and renal involvement: a prospective, randomized study.  Arthritis Rheum. 1998;  41 1835-1844
    CrossrefPubMedGoogle Scholar
  • 37 Hoffman G S, Kerr G S, Leavitt R Y, Hallahan C W, Lebovics R S, Travis W D. et al . Wegener granulomatosis: an analysis of 158 patients.  Ann Intern Med. 1992;  116 488-498
    CrossrefPubMedGoogle Scholar
  • 38 Reinhold-Keller E, Kekow J, Schnabel A, Schmitt W H, Heller M, Beigel A. et al . Influence of disease manifestation and antineutrophil cytoplasmic antibody titer on the response to pulse cyclophosphamide therapy in patients with Wegener’s granulomatosis.  Arthritis Rheum. 1994;  37 919-924
    CrossrefPubMedGoogle Scholar
  • 39 Guillevin L, Lhote F, Leon A, Fauvelle F, Vivitski L, Trepo C. Treatment of polyarteritis nodosa related to hepatitis B virus with short term steroid therapy associated with antiviral agents and plasma exchanges. A prospective trial in 33 patients.  J Rheumatol. 1993;  20 289-298
    PubMedGoogle Scholar
  • 40 Guillevin L, Lhote F, Cohen P, Sauvaget F, Jarrousse B, Lortholary O. et al . Polyarteritis nodosa related to hepatitis B virus. A prospective study with long-term observation of 41 patients.  Medicine. 1995;  74 238-253
    CrossrefPubMedGoogle Scholar
  • 41 Guillevin L, Lhote F, Gayraud M, Cohen P, Jarrousse B, Lortholary O, Thibult N, Casassus P. Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients.  Medicine. 1996;  75 17-28
    CrossrefPubMedGoogle Scholar
  • 42 Lamprecht P, Gause A. Poly(Pan-)arteriitis nodosa, M. Kawasaki. In: Gross WL, ed. Therapie der Immunvaskulitiden. Bremen: UNI-MED 2000: 70-80
    Google Scholar
  • 43 Groot K, Schmidt D K, Arlt A C, Gross W L, Reinhold-Keller E. Standardized neurologic evaluations of 128 patients with Wegener granulomatosis.  Arch Neurol. 2001;  58 1215-1221
    CrossrefPubMedGoogle Scholar
  • 44 Nishino H, Rubino F A, DeRemee R A, Swanson J W, Parisi J E. Neurological involvement in Wegener's granulomatosis. An analysis of 324 consecutive patients at the Mayo Clinic.  Ann Neurol. 1993;  33 4-9
    CrossrefPubMedGoogle Scholar
  • 45 Metzler C, Reinhold-Keller E. Wegenersche Granulomatose. In: Gross WL, editor. Therapie der Immunvaskulitiden. Bremen: UNI-MED 2000: 82-93
    Google Scholar
  • 46 Bajema I M, Hagen E C. Evolving concepts about the role of antineutrophil cytoplasm autoantibodies in systemic vasculitides.  Curr Opin Rheumatol. 1999;  11 34-40
    CrossrefPubMedGoogle Scholar
  • 47 Hagen E C, Daha M R, Hermans J, Andrassy K, Csernok E, Gaskin G. et al . Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. EC/BCR Project for ANCA Assay Standardization.  Kidney Int. 1998;  53 743-753
    CrossrefPubMedGoogle Scholar
  • 48 Jennette J C, Wilkman A S, Falk R J. Diagnostic predictive value of ANCA serology.  Kidney Int. 1998;  53 796-798
    CrossrefPubMedGoogle Scholar
  • 49 McRae D, Buchanan G. Long-term sulfamethoxazole-trimethoprim in Wegener's granulomatosis.  Arch Otolaryngol Head Neck Surg. 1993;  119 103-105
    PubMedGoogle Scholar
  • 50 Valeriano-Marcet J, Spiera H. Treatment of Wegener's granulomatosis with sulfamethoxazole-trimethoprim.  Arch Intern Med. 1991;  151 1649-1652
    CrossrefPubMedGoogle Scholar
  • 51 Guillevin L, Cordier J F, Lhote F, Cohen P, Jarrousse B, Royer I. et al . A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized Wegener's granulomatosis.  Arthritis Rheum. 1997;  40 2187-2198
    CrossrefPubMedGoogle Scholar
  • 52 Steppat D, Gross W L. Stage-adapted treatment of Wegener's granulomatosis. First results of a prospective study.  Klin Wochenschr. 1989;  67 666-671
    CrossrefPubMedGoogle Scholar
  • 53 Groot K, Muhler M, Reinhold-Keller E, Paulsen J, Gross W L. Induction of remission in Wegener's granulomatosis with low dose methotrexate.  J Rheumatol. 1998;  25 492-495
    PubMedGoogle Scholar
  • 54 Langford C A, Talar-Williams C, Barron K S, Sneller M C. A staged approach to the treatment of Wegener's granulomatosis: induction of remission with glucocorticoids and daily cyclophosphamide switching to methotrexate for remission maintenance.  Arthritis Rheum. 1999;  42 2666-2673
    CrossrefPubMedGoogle Scholar
  • 55 Sneller M C, Hoffman G S, Talar-Williams C, Kerr G S, Hallahan C W, Fauci A S. An analysis of forty-two Wegener's granulomatosis patients treated with methotrexate and prednisone.  Arthritis Rheum. 1995;  38 608-613
    CrossrefPubMedGoogle Scholar
  • 56 Stone J H, Tun W, Hellman D B. Treatment of non-life threatening Wegener's granulomatosis with methotrexate and daily prednisone as the initial therapy of choice.  J Rheumatol. 1999;  26 1134-1139
    PubMedGoogle Scholar
  • 57 De Groot K, Reinhold-Keller E, Tatsis E, Paulsen J, Heller M, Nolle B. et al . Therapy for the maintenance of remission in sixty-five patients with generalized Wegener's granulomatosis. Methotrexate versus trimethoprim/sulfamethoxazole.  Arthritis Rheum. 1996;  39 2052-2061
    PubMedGoogle Scholar
  • 58 Reinhold-Keller E, De Groot K, Rudert H, Nolle B, Heller M, Gross W L. Response to trimethoprim/sulfamethoxazole in Wegener's granulomatosis depends on the phase of disease.  QJM. 1996;  89 15-23
    CrossrefPubMedGoogle Scholar
  • 59 Stegeman C A, Cohen Tervaert J W, Jong P E, Kallenberg C G. Trimethoprim-sulfamethoxazole (co-trimoxazole) for the prevention of relapses of Wegener's granulomatosis. Dutch Co-Trimoxazole Wegener Study Group.  N Engl J Med. 1996;  335 16-20
    CrossrefPubMedGoogle Scholar
  • 60 Jayne D R, Chapel H, Adu D, Misbah S, O'Donoghue D, Scott D. et al . Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity.  QJM. 2000;  93 433-439
    CrossrefPubMedGoogle Scholar
  • 61 Talar-Williams C, Hijazi Y M, Walther M M, Linehan W M, Hallahan C W, Lubensky I. et al . Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener granulomatosis.  Ann Intern Med. 1996;  124 477-484
    CrossrefPubMedGoogle Scholar
  • 62 Fauci A S, Haynes B F, Katz P, Wolff S M. Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years.  Ann Intern Med. 1983;  98 76-85
    CrossrefPubMedGoogle Scholar
  • 63 Girard T, Mahr A, Noel L H, Cordier J F, Lesavre P, Andre M H. et al . Are antineutrophil cytoplasmic antibodies a marker predictive of relapse in Wegener's granulomatosis? A prospective study.  Rheumatology (Oxford). 2001;  40 147-151
    CrossrefPubMedGoogle Scholar
  • 64 Chang Y, Kargas S A, Goates J J, Horoupian D S. Intraventricular and subarachnoid hemorrhage resulting from necrotizing vasculitis of the choroid plexus in a patient with Churg-Strauss syndrome.  Clin Neuropathol. 1993;  12 84-87
    PubMedGoogle Scholar
  • 65 Berlit P. Neurologische Manifestationen von Kollagenosen und Vaskulitiden.  Akt Neurol. 2000;  27 405-411
    PubMedGoogle Scholar
  • 66 Lanham J G, Elkon K B, Pusey C D, Hughes G R. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome.  Medicine (Baltimore). 1984;  63 65-81
    CrossrefPubMedGoogle Scholar
  • 67 Metzler C, Tatsis E. Churg-Strauss-Syndrom. In: Gross WL, ed. Therapie der Immunvaskulitiden. Bremen: UNI-MED 2000: 104-113
    Google Scholar
  • 68 Tatsis E, Schnabel A, Gross W L. Interferon-alpha treatment of four patients with the Churg-Strauss syndrome.  Ann Intern Med. 1998;  129 370-374
    CrossrefPubMedGoogle Scholar
  • 69 De Groot K, Reinhold-Keller E. Mikroskopische Polyangiitis. In: Gross WL, ed. Therapie der Immunvaskulitiden. Bremen: UNI-MED 2000: 136
    Google Scholar
  • 70 Askari A, Saadeh A, Buheis N I. Microscopic polyangiitis presenting as schizophrenia.  Rheumatol Int. 1999;  18 215-217
    CrossrefPubMedGoogle Scholar
  • 71 Kono H, Inokuma S, Nakayama H, Yamazaki J. Pachymeningitis in microscopic polyangiitis (MPA): a case report and a review of central nervous system involvement in MPA.  Clin Exp Rheumatol. 2000;  18 397-400
    PubMedGoogle Scholar
  • 72 Deshpande P V, Gilbert R, Alton H, Milford D V. Microscopic polyarteritis with renal and cerebral involvement.  Pediatr Nephrol. 2000;  15 134-135
    CrossrefPubMedGoogle Scholar
  • 73 Ehrlich G E. Vasculitis in Behçet's disease.  Int Rev Immunol. 1997;  14 81-88
    PubMedGoogle Scholar
  • 74 Yazici H, Yurdakul S, Hamuryudan V. Behçet's disease.  Curr Opin Rheumatol. 2001;  13 18-22
    CrossrefPubMedGoogle Scholar
  • 75 Kidd D, Steuer A, Denman A M, Rudge P. Neurological complications in Behçet's syndrome.  Brain. 1999;  122 2183-2194
    CrossrefPubMedGoogle Scholar
  • 76 Akman-Demir G, Serdaroglu P, Tasci B. Clinical patterns of neurological involvement in Behçet's disease: evaluation of 200 patients. The Neuro-Behçet Study Group.  Brain. 1999;  122 2171-2182
    CrossrefPubMedGoogle Scholar
  • 77 Coban O, Bahar S, Akman-Demir G, Tasci B, Yurdakul S, Yazici H. et al . Masked assessment of MRI findings: is it possible to differentiate neuro-Behçet's disease from other central nervous system diseases?.  Neuroradiology. 1999;  41 255-260
    CrossrefPubMedGoogle Scholar
  • 78 Serdaroglu P. Behçet's disease and the nervous system.  J Neurol. 1998;  245 197-205
    PubMedGoogle Scholar
  • 79 Sharief M K, Hentges R, Thomas E. Significance of CSF immunoglobulins in monitoring neurologic disease activity in Behçet's disease.  Neurology. 1991;  41 1398-1401
    PubMedGoogle Scholar
  • 80 Siva A, Fresko I I. Behçet’s Disease.  Curr Treat Options Neurol. 2000;  2 435-448
    PubMedGoogle Scholar
  • 81 Kaklamani V G, Kaklamanis P G. Treatment of Behçet's disease - an update.  Semin Arthritis Rheum. 2001;  30 299-312
    CrossrefPubMedGoogle Scholar
  • 82 Demiroglu H, Ozcebe O I, Barista I, Dundar S, Eldem B. Interferon alfa-2b, colchicine, and benzathine penicillin versus colchicine and benzathine penicillin in Behçet's disease: a randomised trial.  Lancet. 2000;  355 605-609
    CrossrefPubMedGoogle Scholar
  • 83 Sakane T, Takeno M, Suzuki N, Inaba G. Behçet's disease.  N Engl J Med. 1999;  341 1284-1291
    CrossrefPubMedGoogle Scholar
  • 84 Ruiz-Irastorza G, Khamashta M A, Castellino G, Hughes G R. Systemic lupus erythematosus.  Lancet. 2001;  357 1027-1032
    CrossrefPubMedGoogle Scholar
  • 85 Shlomchik M J, Craft J E, Mamula M J. From T to B and back again: positive feedback in systemic autoimmune disease.  Nature Rev Immunol. 2001;  1 147-153
    PubMedGoogle Scholar
  • 86 Sibbitt Jr W L, Sibbitt R R, Brooks W M. Neuroimaging in neuropsychiatric systemic lupus erythematosus.  Arthritis Rheum. 1999;  42 2026-2038
    CrossrefPubMedGoogle Scholar
  • 87 ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature . The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus.  Arthritis Rheum. 1999;  42 599-608
    CrossrefPubMedGoogle Scholar
  • 88 Morton S J, Powell R J. Management of systemic lupus erythematosus (SLE).  Clin Exp Allergy. 2001;  31 686-693
    CrossrefPubMedGoogle Scholar
  • 89 Mosca M, Ruiz-Irastorza G, Khamashta M A, Hughes G R. Treatment of systemic lupus erythematosus.  Int Immunopharmacol. 2001;  1 1065-1075
    PubMedGoogle Scholar
  • 90 Quisimorio F P. Systemic corticosteroid therapy in systemic lupus erythematosus. In: Wallace DJ and Hahn BH, eds. Dubois' lupus erythematosus. Baltimore: Williams & Wilkins 1997: 1141-1162
    Google Scholar
  • 91 Ortmann R A, Klippel J H. Update on cyclophosphamide for systemic lupus erythematosus.  Rheum Dis Clin North Am. 2000;  26 363-375, vii
    PubMedGoogle Scholar
  • 92 Gourley M F, Austin H A, Scott D, Yarboro C H, Vaughan E M, Muir J. et al . Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial.  Ann Intern Med. 1996;  125 549-557
    PubMedGoogle Scholar
  • 93 Illei G G, Austin H A, Crane M, Collins L, Gourley M F, Yarboro C H. et al . Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis.  Ann Intern Med. 2001;  135 248-257
    PubMedGoogle Scholar
  • 94 Takada K, Illei G G, Boumpas D T. Cyclophosphamide for the treatment of systemic lupus erythematosus.  Lupus. 2001;  10 154-161
    CrossrefPubMedGoogle Scholar
  • 95 D'Cruz D, Cuadrado M J, Mujic F, Tungekar M F, Taub N, Lloyd M. et al . Immunosuppressive therapy in lupus nephritis.  Clin Exp Rheumatol. 1997;  15 275-282
    PubMedGoogle Scholar
  • 96 Chan T M, Li F K, Hao W K, Chan K W, Lui S L, Tang S. et al . Treatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppression.  Lupus. 1999;  8 545-551
    CrossrefPubMedGoogle Scholar
  • 97 Chan T M, Li F K, Tang C S, Wong R W, Fang G X, Ji Y L. et al . Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group.  N Engl J Med. 2000;  343 1156-1162
    CrossrefPubMedGoogle Scholar
  • 98 Mok C C, Ho C T, Chan K W, Lau C S, Wong R W. Outcome and prognostic indicators of diffuse proliferative lupus glomerulonephritis treated with sequential oral cyclophosphamide and azathioprine.  Arthritis Rheum. 2002;  46 1003-1013
    CrossrefPubMedGoogle Scholar
  • 99 Ruiz-Irastorza G, Khamashta M A, Hughes G R. Antiaggregant and anticoagulant therapy in systemic lupus erythematosus and Hughes' syndrome.  Lupus. 2001;  10 241-245
    CrossrefPubMedGoogle Scholar
  • 100 Moore P, Richardson B. Neurology of the vasculitides and connective tissue diseases.  J Neurol Neurosurg Psychiat. 1998;  65 10-22
    CrossrefPubMedGoogle Scholar
  • 101 Alexander E L, Ranzenbach M R, Kumar A J, Kozachuk W E, Rosenbaum A E, Patronas N, Harley J B, Reichlin M. Anti-Ro (SS-A) autoantibodies in central nervous system disease associated with Sjögren's syndrome (CNS-SS): Clinical, neuroimaging, and angiographic correlates.  Neurology. 1994;  44 89-908
    PubMedGoogle Scholar

Prof. Dr med. P. Berlit

Alfried-Krupp-Krankenhaus

Alfried-Krupp-Straße 21

45117 Essen

Email: peter.berlit@krupp-krankenhaus.de

      >