Skip to main content

Advertisement

SpringerLink
Log in

Diagnose und Therapie neurologischer Manifestationen bei entzündlich-rheumatischen Erkrankungen

Diagnosis and therapy of neurological manifestations of inflammatory rheumatic diseases

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Entzündlich-rheumatische Erkrankungen können neben den bekannten muskuloskelettalen Manifestationen auch das zentrale und periphere Nervensystem betreffen. Die möglichen Symptome sind dabei genauso vielfältig wie die Krankheitsmechanismen, die sie hervorrufen können. Eine rasche diagnostische Abklärung, die Einleitung einer adäquaten Therapie und ein regelmäßiges Monitoring dieser Patienten sind notwendig, um bleibende Behinderungen abzuwenden. In diesem Artikel werden aktuelle Ansätze der Diagnostik und Therapie neurologischer Manifestationen bei entzündlich-rheumatischen Erkrankungen wie systemischer Lupus erythematodes, M. Behçet, Sjögren-Syndrom, systemische Vaskulitiden und Sarkoidose zusammengefasst.

Abstract

Patients with inflammatory rheumatic diseases frequently report symptoms that may indicate an involvement of central and peripheral nervous system in addition to the known musculoskeletal symptoms. The possible symptoms can be as varied as the disease mechanism which causes them. Early correct diagnosis, adequate therapy and regular monitoring of these patients are necessary to prevent permanent disability. This article summarizes current literature on the diagnosis and therapy of neurological manifestations of inflammatory rheumatic diseases including systemic Lupus erythematodes, Behçet’s disease, Sjögren’s syndrome, systemic vasculitides and sarcoidosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Neuhaus O, Hartung H (2004) Neurological aspects of systemic rheumatological disorders. Z Rheumatol 63: 104–112

    Article  PubMed  CAS  Google Scholar 

  2. Nomenclature AAHCoNL (1999) The American college of rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42: 599–608

    Article  Google Scholar 

  3. Berlit P, Melms A, Seidel G et al. (2005) Zerebrale Vaskulitis. In: Diener H, Putzki N, Berlit P et al. (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie, 3. Aufl. Thieme, Stuttgart, S 268–283

  4. Weiner SM, Otte A, Uhl M et al. (2003) Neuropsychiatric involvement in systemic lupus erythematosus. Part 2: diagnostic and therapy. Med Klin 98: 79–90

    Article  Google Scholar 

  5. Fazekas F, Schmidt R, Kleinert R et al. (1998) The spectrum of age-associated brain abnormalities: their measurement and histopathological correlates. J Neural Transm 53 (Suppl): S31–S39

    Google Scholar 

  6. Wingerchuk D, Lennon V, Lucchinetti C et al. (2007) The spectrum of neuromyelitis optica. Lancet Neurol 6: 805–815

    Article  PubMed  CAS  Google Scholar 

  7. Ling MH, Perry PJ, Tsuang MT (1981) Side effects of corticosteroid therapy. Psychiatric aspects. Arch Gen Psychiatry 38: 471–477

    PubMed  CAS  Google Scholar 

  8. Barile-Fabris L, Ariza-Andraca R, Olguin-Ortega L et al. (2005) Controlled clinical trial of IV cyclophosphamide versus IV methylprenisolone in severe neurological manifestations in systemic lupus erythematous. Ann Rheum Dis 64: 620–625

    Article  PubMed  CAS  Google Scholar 

  9. Wang C, Fortin PR, Li Y et al. (1999) Discontinuation of antimalarial drugs in systemic lupus erythematosus. J Rheumatol 26: 808–815

    PubMed  CAS  Google Scholar 

  10. Tokunaga M, Saito K, Kawabata D et al. (2007) Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system. Ann Rheum Dis 66: 470–475

    Article  PubMed  CAS  Google Scholar 

  11. Erkan D, Harrison MJ, Levy R et al. (2007) Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: a randomized, double-blind, placebo-controlled trial in asymptomatic antiphospholipid antibody-positive individuals. Arthritis Rheum 56: 2382–2391

    Article  PubMed  CAS  Google Scholar 

  12. Kidd D, Steuer A, Denman A et al. (1999) Neurological complications in Behçet’s syndrome. Brain 122: 2183–2194

    Article  PubMed  Google Scholar 

  13. Hatemi G, Silman A, Bang D et al. (2008) Management of behcet’s disease: a systematic literature review for the EULAR evidence based recommendations for the management of behcet’s disease. Ann Rheum Dis [Epub ahead of print]

  14. Akman-Demir G, Serdaroglu P, Tasçi B (1999) Clinical patterns of neurological involvement in Behçet’s disease: evaluation of 200 patients. The Neuro-Behçet Study Group. Brain 122: 2171–2182

    Article  PubMed  Google Scholar 

  15. Pipitone N, Olivieri I, Padula A et al. (2008) Infliximab for the treatment of Neuro-Behçet’s disease: a case series and review of the literature. Arthritis Rheum 59: 285–290

    Article  PubMed  CAS  Google Scholar 

  16. Anaya J, Villa L, Restrepo L et al. (2002) Central nervous system compromise in primary Sjögren’s syndrome. J Clin Rheumatol 8: 189–196

    Article  PubMed  Google Scholar 

  17. Delalande S, de Seze J, Fauchais A et al. (2004) Neurologic manifestations in primary Sjögren syndrome: a study of 82 patients. Medicine 83: 280–291

    Article  PubMed  Google Scholar 

  18. Govoni M, Padovan M, Rizzo N et al. (2001) CNS involvement in primary Sjögren’s syndrome: prevalence, clinical aspects, diagnostic assessment and therapeutic approach. CNS Drugs 15: 597–607

    Article  PubMed  CAS  Google Scholar 

  19. Terrier B, Lacroix C, Guillevin L et al. (2007) Diagnostic and prognostic relevance of neuromuscular biopsy in primary Sjögren’s syndrome-related neuropathy. Arthritis Rheum 57: 1520–1529

    Article  PubMed  Google Scholar 

  20. Yamout B, El-Hajj T, Barada W et al. (2007) Successful treatment of refractory neuroSjogren with Rituximab. Lupus 16: 521–523

    Article  PubMed  CAS  Google Scholar 

  21. Siva A (2001) Vasculitis of the nervous system. J Neurol 248: 451–468

    Article  PubMed  CAS  Google Scholar 

  22. Dejaco C, Duftner C, Schirmer M (2007) Therapie der Polymyalgia rheumatica und Riesenzellarteritis. Jatros Orthopädie 5: 40–41

    Google Scholar 

  23. Hunder GG, Bloch DA, Michel BA et al. (1990) The American college of rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 33: 1122–1128

    PubMed  CAS  Google Scholar 

  24. Mahr AD, Jover JA, Spiera RF et al. (2007) Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum 56: 2789–2797

    Article  PubMed  CAS  Google Scholar 

  25. Berlit P (2004) Cerebral vasculitis Nervenarzt 75: 817–828

  26. Wegener’s Granulomatosis Etanercept Trial (WGET) Research Group (2005) Etanercept plus standard therapy for Wegener’s granulomatosis. N Engl J Med 352: 351–361

    Article  Google Scholar 

  27. Zwerina J (2008) Churg-Strauss syndrome. Z Rheumatol 67: 137–143

    Article  PubMed  CAS  Google Scholar 

  28. Tsurikisawa N, Taniguchi M, Saito H et al. (2004) Treatment of churg-strauss syndrome with high-dose intravenous immunoglobulin. Ann Allergy Asthma Immunol 92: 80–87

    Article  PubMed  CAS  Google Scholar 

  29. Hoitsma E, Faber C, Drent M et al. (2004) Neurosarcoidosis: a clinical dilemma. Lancet Neurol 3: 397–407

    Article  PubMed  Google Scholar 

  30. Nowak DA, Widenka DC (2001) Neurosarcoidosis: a review of its intracranial manifestation. J Neurol 248: 363–372

    Article  PubMed  CAS  Google Scholar 

Download references

Danksagung

Unterstützt wurde diese Arbeit vom Krankenhaus der Elisabethinen, Klagenfurt.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Innere Medizin, Krankenhaus der Elisabethinen, Völkermarkterstr. 15-19, 9020, Klagenfurt, Österreich

    C. Dejaco, C. Duftner & M. Schirmer

  2. Univ.-Klinik für Neurologie, Medizinische Universität Graz, Graz, Österreich

    T. Seifert, M.K. Storch & F. Fazekas

Authors
  1. C. Dejaco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Duftner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M.K. Storch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Fazekas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Schirmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to C. Dejaco or T. Seifert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dejaco, C., Seifert, T., Duftner, C. et al. Diagnose und Therapie neurologischer Manifestationen bei entzündlich-rheumatischen Erkrankungen. Z. Rheumatol. 67, 386–396 (2008). https://doi.org/10.1007/s00393-008-0339-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-008-0339-9

Schlüsselwörter

Keywords

Search

Navigation