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Semin Neurol 2003; 23(2): 207-214
DOI: 10.1055/s-2003-41133
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Therapy of Neurological Disorders in Systemic Vasculitis

Ralf Gold1 , Adriano Fontana2 , Stephan Zierz3
  • 1Department of Neurology, Clinical Research Group for Multiple Sclerosis and Neuroimmunology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
  • 2Department of Clinical Immunology, University Hospital Zürich, Zürich, Switzerland
  • 3Department of Neurology, University of Halle-Wittenberg, Halle/Saale, Germany
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Publication History

Publication Date:
01 August 2003 (online)

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ABSTRACT

Significant progress has been made in our understanding of the underlying cellular and molecular mechanisms associated with vasculitis. Simultaneous involvement of the nervous system and systemic organs points to shared antigenic targets or immune mechanisms operative at both sites. Although specific immunotherapy is not available, the old and new immunomodulatory therapies have been instrumental in providing effective therapy in most of these chronic autoimmune disorders. The treatment of giant cell arteritis, neurosarcoidosis, Wegener's granulomatosis, systemic lupus erythematosus, polyarteritis, Sjögren's syndrome, and Behcet disease will be reviewed.

KEYWORDS

Autoimmunity - nervous system - therapy - vasculitis

REFERENCES

  • 1 Medawar P. Immunity to homologous grafted skin III: the fate of skin homografts transplanted to the brain, to subcutaneous tissue, and to the anterior chamber of the eye.  Br J Exp Path . 1948;  29 58-69
    PubMedSearch in Google Scholar
  • 2 Wekerle H, Linington C, Lassmann H, Meyermann R. Cellular immune reactivity within the CNS.  Trends Neurosci . 1986;  9 271-277
    CrossrefPubMedSearch in Google Scholar
  • 3 Janeway C A, Travers P, Walport M, Shlomchik M J. Immunobiology: The Immune System in Health and Disease. New York: Churchill Livingstone 2001
    Search in Google Scholar
  • 4 Vincent A, Martino G. Autoantibodies in Neurological Diseases. 1st ed. Milano: Springer Verlag Italia 2002
    Search in Google Scholar
  • 5 Lehmann P V, Forsthuber T, Miller A, Sercarz E E. Spreading of T-cell autoimmunity to cryptic determinants of an autoantigen.  Nature . 1992;  358 155-157
    CrossrefPubMedSearch in Google Scholar
  • 6 Harper L, Ren Y, Savill J, Adu D, Savage C O. Antineutrophil cytoplasmic antibodies induce reactive oxygen-dependent dysregulation of primed neutrophil apoptosis and clearance by macrophages.  Am J Pathol . 2000;  157 211-220
    PubMedSearch in Google Scholar
  • 7 Harper L, Savage C O. Leukocyte-endothelial interactions in antineutrophil cytoplasmic antibody-associated systemic vasculitis.  Rheum Dis Clin North Am . 2001;  27 887-903
    CrossrefPubMedSearch in Google Scholar
  • 8 Gold R, Buttgereit F, Toyka K V. Mechanism of action of glucocorticosteroid hormones: possible implications for therapy of neuroimmunological disorders.  J Neuroimmunol . 2001;  117 1-8
    CrossrefPubMedSearch in Google Scholar
  • 9 Dalakas M C. Intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: present status and practical therapeutic guidelines.  Muscle Nerve . 1999;  22 1479-1497
    CrossrefPubMedSearch in Google Scholar
  • 10 Salvarani C, Cantini F, Boiardi L, Hunder G G. Polymyalgia rheumatica and giant-cell arteritis.  N Engl J Med . 2002;  347 261-271
    CrossrefPubMedSearch in Google Scholar
  • 11 LeVine S M, Hellmann D B. Giant cell arteritis.  Curr Opin Rheumatol . 2002;  14 3-10
    CrossrefPubMedSearch in Google Scholar
  • 12 Jover J A, Hernandez-Garcia C, Morado I C, Vargas E, Banares A, Fernandez-Gutierrez B. Combined treatment of giant-cell arteritis with methotrexate and prednisone: a randomized, double-blind, placebo-controlled trial.  Ann Intern Med . 2001;  134 106-114
    CrossrefPubMedSearch in Google Scholar
  • 13 Hoffman G S, Cid M C, Hellmann D B. et al . A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis.  Arthritis Rheum . 2002;  46 1309-1318
    CrossrefPubMedSearch in Google Scholar
  • 14 Gullapalli D, Phillips L H. Neurologic manifestations of sarcoidosis.  Neurol Clin . 2002;  20 59-83
    CrossrefPubMedSearch in Google Scholar
  • 15 Nowak D A, Widenka D C. Neurosarcoidosis: a review of its intracranial manifestation.  J Neurol . 2001;  248 363-372
    CrossrefPubMedSearch in Google Scholar
  • 16 Ferriby D, De Seze J, Stojkovic T. et al . Long-term follow-up of neurosarcoidosis.  Neurology . 2001;  57 927-929
    CrossrefPubMedSearch in Google Scholar
  • 17 Ferriby D, De Seze J, Stojkovic T. et al . Clinical manifestations and therapeutic approach in neurosarcoidosis [in French].  Rev Neurol (Paris) . 2000;  156 965-975
    PubMedSearch in Google Scholar
  • 18 Agbogu B N, Stern B J, Sewell C, Yang G. Therapeutic considerations in patients with refractory neurosarcoidosis.  Arch Neurol . 1995;  52 875-879
    CrossrefPubMedSearch in Google Scholar
  • 19 Leavitt R Y, Fauci A S, Bloch D A. et al . The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis.  Arthritis Rheum . 1990;  33 1101-1107
    CrossrefPubMedSearch in Google Scholar
  • 20 Hoffman G S, Kerr G S, Leavitt R Y. et al . Wegener granulomatosis: an analysis of 158 patients.  Ann Intern Med . 1992;  116 488-498
    CrossrefPubMedSearch in Google Scholar
  • 21 De Groot K, Adu D, Savage C O. The value of pulse cyclophosphamide in ANCA-associated vasculitis: meta-analysis and critical review.  Nephrol Dial Transplant . 2001;  16 2018-2027
    PubMedSearch in Google Scholar
  • 22 Jayne D R, Rasmussen N. Treatment of antineutrophil cytoplasm autoantibody-associated systemic vasculitis: initiatives of the European Community Systemic Vasculitis Clinical Trials Study Group.  Mayo Clin Proc . 1997;  72 737-747
    CrossrefPubMedSearch in Google Scholar
  • 23 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
    CrossrefPubMedSearch in Google Scholar
  • 24 Hoffman G S, Leavitt R Y, Kerr G S, Fauci A S. The treatment of Wegener's granulomatosis with glucocorticoids and methotrexate.  Arthritis Rheum . 1992;  35 1322-1329
    PubMedSearch in Google Scholar
  • 25 Stegeman C A, Tervaert J W, de Jong E P, 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
    CrossrefPubMedSearch in Google Scholar
  • 26 Lightfoot Jr W R, Michel B A, Bloch D A. et al . The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa.  Arthritis Rheum . 1990;  33 1088-1093
    PubMedSearch in Google Scholar
  • 27 Genereau T, Lortholary O, Leclerq P. et al . Treatment of systemic vasculitis with cyclophosphamide and steroids: daily oral low-dose cyclophosphamide administration after failure of a pulse intravenous high-dose regimen in four patients.  Br J Rheumatol . 1994;  33 959-962
    PubMedSearch in Google Scholar
  • 28 Brey R L, Holliday S L, Saklad A R. et al . Neuropsychiatric syndromes in lupus: prevalence using standardized definitions.  Neurology . 2002;  58 1214-1220
    CrossrefPubMedSearch in Google Scholar
  • 29 Kimberly R P. Treatment: corticosteroids and anti-inflammatory drugs.  Rheum Dis Clin North Am . 1988;  14 203-221
    PubMedSearch in Google Scholar
  • 30 Houssiau F A, Vasconcelos C, D'Cruz D. et al . Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide.  Arthritis Rheum . 2002;  46 2121-2131
    CrossrefPubMedSearch in Google Scholar
  • 31 Drosos A A, Andonopoulos A P, Costopoulos J S, Papadimitriou C S, Moutsopoulos H M. Prevalence of primary Sjögren's syndrome in an elderly population.  Br J Rheumatol . 1988;  27 123-127
    PubMedSearch in Google Scholar
  • 32 Vitali C, Bencivelli W, Isenberg D A. et al . Disease activity in systemic lupus erythematosus-report of the Consensus Study Group of the European Workshop for Rheumatology Research I: a descriptive analysis of 704 European lupus patients. European Consensus Study Group for Disease Activity in SLE.  Clin Exp Rheumatol . 1992;  10 527-539
    PubMedSearch in Google Scholar
  • 33 Caroyer J M, Manto M U, Steinfeld S D. Severe sensory neuronopathy responsive to infliximab in primary Sjögren's syndrome.  Neurology . 2002;  59 1113-1114
    CrossrefPubMedSearch in Google Scholar
  • 34 Ohno S, Ohguchi M, Hirose S, Matsuda H, Wakisaka A, Aizawa M. Close association of HLA-Bw51 with Behcet's disease.  Arch Ophthalmol . 1982;  100 1455-1458
    CrossrefPubMedSearch in Google Scholar
  • 35 Yazici H, Pazarli H, Barnes C G. et al . A controlled trial of azathioprine in Behcet's syndrome.  N Engl J Med . 1990;  322 281-285
    PubMedSearch in Google Scholar