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Arthritis und Rheuma 2018; 38(01): 27-33
DOI: 10.1055/s-0038-1636988
Organbeteiligung bei Rheuma
Schattauer GmbH

Entzündlich-rheumatische Erkrankungen und neurologische Manifestationen

Neurological involvement in inflammatory rheumatological diseases
J. Röther
1   Kopfund Neurozentrum, Neurologische Abteilung mit überregionaler Stroke Unit, Neurophysiologie und Neurologischer Intensivmedizin, Asklepios Klinik Altona
,
A. Bickel
1   Kopfund Neurozentrum, Neurologische Abteilung mit überregionaler Stroke Unit, Neurophysiologie und Neurologischer Intensivmedizin, Asklepios Klinik Altona
,
I. Kötter
2   Rheumatologie, klinische Immunologie, Nephrologie, Asklepios Klinik Altona
› Author Affiliations
Further Information

Publication History

Publication Date:
04 April 2018 (online)

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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
 

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