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Neuroimmunologie und Rheumatologie: Schnittmengen und Differenzialdiagnosen

Neuroimmunology and rheumatology: overlap and differential diagnoses

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Zusammenfassung

Die multiple Sklerose (MS) und die Neuromyelitis-optica-Spektrum-Erkrankungen (NMOSD) sind chronisch-entzündliche Erkrankungen des zentralen Nervensystems (ZNS), die mit multifokalen entzündlichen Läsionen im Gehirn, Rückenmark und Sehnerv einhergehen können. Beide Erkrankungen sind manchmal schwer von ZNS-Manifestationen einer systemisch-entzündlichen Erkrankung aus dem rheumatologischen Formenkreis wie einem systemischen Lupus erythematodes (SLE), einem Sjögren-Syndrom, autoinflammatorischen Syndromen oder einer Sarkoidose zu unterscheiden, da auch bei diesen Erkrankungen unter anderem Myelitiden oder N.-opticus-Neuritiden auftreten können. Andererseits können eine MS und eine NMOSD auch gemeinsam mit einer rheumatologischen Erkrankung auftreten. Insbesondere bei der NMOSD wird eine Koexistenz mit einem SLE oder Sjögren-Syndrom häufig beobachtet. Da die therapeutischen Prinzipien unterschiedlich sind, sollte eine differenzialdiagnostische Abgrenzung immer angestrebt werden. Zudem können sich unter bestimmten Therapien, beispielsweise nach Therapie mit einem Tumor-Nekrose-Faktor-Blocker, entzündliche ZNS-Erkrankungen entwickeln. Insofern sind interdisziplinäre Sprechstunden und die Nutzung von Synergieeffekten der beiden Fachrichtungen Neuroimmunologie und Rheumatologie nur zu unterstützen.

Abstract

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are chronic inflammatory diseases of the central nervous system (CNS). They may cause inflammation in the brain, spinal cord and optic nerve. Both conditions must be differentiated from CNS manifestations of other systemic autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren’s syndrome, autoinflammtory diseases and sarcoidosis, since amongst others myelitis and optic nerve inflammation may also occur in these conditions. Nevertheless, coexistence of MS or NMOSD with rheumatic disorders such as SLE or Sjögren’s syndrome has also been reported especially in NMOSD. Since the therapeutic approach is different it is important to determine a clear diagnosis. In addition some drugs used in rheumatic disease such as anti-tumor necrosis factor biologics may induce inflammatory disease of the CNS and should be avoided in MS. An interdisciplinary approach between neuroimmunology and rheumatology is important for optimal care and treatment in such patients.

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Danksagung

Frau Rebecca Gravert ist für die sekretarielle Unterstützung zu danken.

Förderung

Die Arbeiten von Frau Kümpfel und Frau Trebst im Bereich der Neuromyelitis-optica-Spektrum-Erkrankungen (NationNMO-Kohorte) werden derzeit im Rahmen der dritten Förderperiode des Kompetenznetzes Multiple Sklerose (KKNMS) vom Bundesministerium für Bildung und Forschung (BMBF) gefördert (FKZ 01GI1602B).

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Authors and Affiliations

  1. Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    C. Trebst

  2. Institut für klinische Neuroimmunologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    T. Kümpfel

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  1. C. Trebst
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Correspondence to T. Kümpfel.

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Interessenkonflikt

C. Trebst hat Honorare für Vorträge auf Fortbildungsveranstaltungen von Biogen Idec/GmbH, Genzyme GmbH und Novartis Pharmaceuticals erhalten. Dies hatte keinen Einfluss auf die vorliegende Arbeit. T. Kümpfel erhielt finanzielle Unterstützung für Reisen und Vortragstätigkeiten von Bayer Healthcare, Teva Pharma, Merck, Novartis Pharma, Sanofi-Aventis/Genzyme, CLB Behring, Roche Pharma und Biogen sowie Unterstützung für wissenschaftliche Projekte von Bayer-Schering AG, Novartis und Chugai Pharma. Dies hatte keinen Einfluss auf die vorliegende Arbeit.

Dieser Beitrag beinhaltet keine von den Autorinnen durchgeführten Studien an Menschen oder Tieren.

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Trebst, C., Kümpfel, T. Neuroimmunologie und Rheumatologie: Schnittmengen und Differenzialdiagnosen. Nervenarzt 89, 1095–1105 (2018). https://doi.org/10.1007/s00115-018-0597-y

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