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Aktuelle Rheumatologie 2001; 26(6): 285-290
DOI: 10.1055/s-2001-19065
RHEUMATOLOGIE UND NEUROLOGIE
© Georg Thieme Verlag Stuttgart · New York

Neurologische Komplikationen der Therapie rheumatischer Erkrankungen

Neurologic Complications of Therapy in Rheumatic DiseasesC. A. Böger, H. Kellner
  • Rheuma-Einheit (Leiter: Prof. Dr. med. M. Schattenkirchner), Medizinische Poliklinik, Klinikum der Universität, Innenstadt, München
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Publication History

Publication Date:
17 December 2001 (online)

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Zusammenfassung

Die Therapie der meisten entzündlich rheumatischen Erkrankungen beinhaltet grundsätzlich mindestens eines der zahlreichen Basistherapeutika (krankheitsmodifizierende Therapie). Je nach Krankheitsaktivität erfolgt die additive Gabe von Glukokortikoiden, nicht-steroidalen Antirheumatika (NSAR) und Analgetika. Neben dem belegten therapeutischen Nutzen der jeweiligen Therapien besteht ein signifikantes Nebenwirkungspotenzial bei sämtlichen Substanzen. In dieser Übersicht werden die neurologischen Nebenwirkungen beleuchtet und Vorschläge zu deren Prävention und Therapie gemacht.

Neurologic Complications of Therapy in Rheumatic Diseases

The therapy of most inflammatory rheumatic diseases comprises at least one disease-modifying anti-rheumatic drug (DMARD). Depending on the disease activity, additional therapy with corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics is performed. Unfortunately, there is a significant profile of adverse effects of each of these substance groups, frequently leading to discontinuation of therapy. In this review, the adverse neurological effects of the antirheumatic agents are reviewed and recommendations for their prevention and treatment are made.

Literatur

  • 1 Amos R S, Pullar T, Bax D E, Situnayake D, Capell H A, McConkey B. Sulphasalazine for rheumatoid arthritis: toxicity in 774 patients monitored for one to 11 years.  Br Med J (Clin Res Ed). 1986;  293 420-423
    PubMedGoogle Scholar
  • 2 Avina-Zubieta J A, Johnson E S, Suarez-Almazor M E, Russell A S. Incidence of myopathy in patients treated with antimalarials. A report of three cases and a review of the literature.  Br J Rheumatol. 1995;  34 166-170
    PubMedGoogle Scholar
  • 3 Bernstein H N. Ocular safety of hydroxychloroquine.  Ann Ophthalmol. 1991;  23 292-295
    PubMedGoogle Scholar
  • 4 Black A J, McLeod H L, Capell H A, Powrie R H, Matowe L K, Pritchard S C, Collie-Duguid E S, Reid D M. Thiopurine methyltransferase genotype predicts therapy-limiting severe toxicity from azathioprine.  Ann Intern Med. 1998;  129 716-718
    PubMedGoogle Scholar
  • 5 Boonen S, Van Distel G, Westhovens R, Dequeker J. Steroid myopathy induced by epidural triamcinolone injection.  Br J Rheumatol. 1995;  34 385-386
    PubMedGoogle Scholar
  • 6 Box S A, Pullar T. Sulphasalazine in the treatment of rheumatoid arthritis.  Br J Rheumatol. 1997;  36 382-386
    CrossrefPubMedGoogle Scholar
  • 7 Canadian rheumatology association . Canadian Consensus Conference on hydroxychloroquine.  J Rheumatol. 2000;  27 2919-2921
    PubMedGoogle Scholar
  • 8 Easterbrook M. Ocular effects and safety of antimalarial agents.  Am J Med. 1988;  85 23-29
    PubMedGoogle Scholar
  • 9 Eidelman B H, Abu-Elmagd K, Wilson J, Fung J J, Alessiani M, Jain A, Takaya S, Todo S N, Tzakis A, Van Thiel D et al. Neurologic complications of FK 506.  Transplant Proc. 1991;  23 3175-3178
    PubMedGoogle Scholar
  • 10 Estes M L, Ewing-Wilson D, Chou S M, Mitsumoto H, Hanson M, Shirey E, Ratliff N B. Chloroquine neuromyotoxicity. Clinical and pathologic perspective.  Am J Med. 1987;  82 447-455
    CrossrefPubMedGoogle Scholar
  • 11 European FK506 Multicentre Liver Study Group . Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection.  Lancet. 1994;  344 423-428
    PubMedGoogle Scholar
  • 12 Fam A G, Gordon D a, Sarkozi J, Blair G R, Cooper P W, Harth M, Lewis A J. Neurologic complications associated with gold therapy for rheumatoid arthritis.  J Rheumatol. 1984;  11 700-706
    PubMedGoogle Scholar
  • 13 Felson D T, Anderson J J, Meenan R F. The efficacy and toxicity of combination therapy in rheumatoid arthritis. Results of two meta-analyses.  Arthritis Rheum. 1994;  37 1487-1491
    PubMedGoogle Scholar
  • 14 Hoppmann R A, Peden J G, Ober S K. Central nervous system side effects of nonsteroidal anti-inflammatory drugs. Aseptic meningitis, psychosis, and cognitive dysfunction.  Arch Intern Med. 1991;  151 1309-1313
    CrossrefPubMedGoogle Scholar
  • 15 Howard-Lock H E, Lock C JC, Mewz A, Kean W F. D-Penicillamine: chemistry and clinical use in rheumatic disease.  Sem Arthritis Rheum. 1986;  15 261-281
    PubMedGoogle Scholar
  • 16 Keenan P A, Jacobson M W, Soleymani R M, Mayes M D, Stress M E, Yaldoo D T. The effect on memory of chronic prednisone treatment in patients with systemic disease.  Neurology. 1996;  47 1396-1402
    PubMedGoogle Scholar
  • 17 Kerschner P, Wang-Cheng R. Psychiatric side effects of steroid therapy.  Psychosomatics. 1989;  30 135
    CrossrefPubMedGoogle Scholar
  • 18 Kremer J M, Phelps C T. Long-term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis.  Arthritis Rheum. 1992;  35 138-145
    CrossrefPubMedGoogle Scholar
  • 19 Lange A E, Humphrey J G. Plasma exchange treatment for severe penicillamine induced myasthenia gravis.  J Rheumatol. 1981;  8 169
    PubMedGoogle Scholar
  • 20 Maini R, St Clair E W, Breedveld F, Furst D, Kalden J, Weisman M, Smolen J, Emery P, Harriman G, Feldmann M, Lipsky P et al. Infliximab (chimeric antitumor necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trialSM. ATTRACT Study Group.  Lancet. 1999;  354 1932-1939
    CrossrefPubMedGoogle Scholar
  • 21 Middleton G D, McFarlin J E, Lipsky P E. Hydroxychloroquine and pain thresholds.  Arthritis Rheum. 1995;  38 445-447
    PubMedGoogle Scholar
  • 22 Mohan N, Edwards E T, Cupps T R, Oliverio P J, Siegel J N. Demyelination diagnosed during etanercept therapy.  Arthritis Rheum. 2000;  43 970
    PubMedGoogle Scholar
  • 23 Morgan S L, Baggott J E, Vaughn W H, Austin J S, Veitch T A, Lee J Y, Koopman W J, Krumdieck C L, Alarcon G S. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial.  Ann Intern Med. 1994;  121 833-841
    PubMedGoogle Scholar
  • 24 Naber D, Sand P, Heigl B. Psychopathological and neuropsychological effects of 8-days’ corticosteroid treatment. A prospective study.  Psychoneuroendocrinology. 1996;  21 25-31
    CrossrefPubMedGoogle Scholar
  • 25 Ortiz Z, Shea B, Suarez-Almazor M E, Moher D, Wells G A, Tugwell P. The efficacy of folic acid and folinic acid in reducing methotrexate gastrointestinal toxicity in rheumatoid arthritis. A metaanalysis of randomized controlled trials.  J Rheumatol. 1998;  25 36-43
    PubMedGoogle Scholar
  • 26 Quinn C T, Kamen B A. A biochemical perspective of methotrexate neurotoxicity with insight on nonfolate rescue modalities.  J Investig Med. 1996;  44 522-530
    PubMedGoogle Scholar
  • 27 Rau R. Methotrexat.  In: Basistherapie der rheumatoiden Arthritis. 1. Auflage. Uni-Med Verlag 2000: 192
    Google Scholar
  • 28 Schattenkirchner M, Krüger K, Sander O et al. Efficacy and tolerability of weekly subcutaneous injections of the fully human anti-TNF antibody D2E7 in patients with rheumatoid arthritis.  Arthritis Rheum. 1998;  41 57
    PubMedGoogle Scholar
  • 29 Serre H et al. Syndrome de Guillain-Barré après chrysotherapie.  Rheumatol. 1975;  27 467
    PubMedGoogle Scholar
  • 30 Simon L S, Mills J A. Drug therapy: nonsteroidal antiinflammatory drugs (first of two parts).  N Engl J Med. 1980;  302 1179-1185
    PubMedGoogle Scholar
  • 31 Taylor H G, Samanta A. Penicillamine in rheumatoid arthritis.  Drug Saf. 1992;  7 46-53
    PubMedGoogle Scholar
  • 32 van Oosten B W, Barkhof F, Truyen L, Boringa J B, Bertelsmann F W, von Blomberg B M, Woody J N, Hartung H P, Polman C H. Increased MRI activity and immune activation in two multiple sclerosis patients treated with the monoclonal anti-tumor necrosis factor antibody cA2.  Neurology. 1996;  47 1531-1534
    CrossrefPubMedGoogle Scholar
  • 33 Weinblatt M E, Kaplan H, Germain B F. Methotrexate in rheumatoid arthritis: effects on disease activity in a multicenter prospective study.  J Rheumatol. 1991;  18 334-338
    PubMedGoogle Scholar
  • 34 Weinblatt M E, Maier A L, Fraser P A, Coblyn J S. Longterm prospective study of methotrexate in rheumatoid arthritis: conclusion after 132 months of therapy.  J Rheumatol. 1998;  25 238-242
    PubMedGoogle Scholar
  • 35 Weinstein G D, Roenigk H, Maibach H I. Psoriasis liver methotrexate interactions.  Arch Dermatol. 1973;  108 36
    CrossrefPubMedGoogle Scholar
  • 36 Wijdicks E F, Wiesner R H, Krom R A. Neurotoxicity in liver transplant recipients with cyclosporine immunosuppression.  Neurology. 1995;  45 1962-1964
    CrossrefPubMedGoogle Scholar
  • 37 Wooley P H, Griffin J, Panayi G S, Patchelor J R, Welsh K I, Gibson T J. HLA-DR antigens and toxic reaction to sodium aurothiomalate and D-penicillamine in patients with rheumatoid arthritis.  N Engl J Med. 1980;  303 300-302
    PubMedGoogle Scholar

Dr. med. C. Böger

Rheuma-Einheit, Medizinische Poliklinik
Klinikum der Universität, Innenstadt

Pettenkoferstraße 8a
80336 München

Email: carsten.boeger@gmx.net