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风湿性疾病的中枢神经系统表现。

Central nervous system manifestations in rheumatic diseases.

机构信息

2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.

Department of Neurology, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.

出版信息

Rheumatol Int. 2024 Oct;44(10):1803-1812. doi: 10.1007/s00296-024-05679-1. Epub 2024 Aug 13.

Abstract

As the role of neurologists in managing patients with rheumatic diseases expands, collaboration between rheumatologists and neurologists becomes increasingly vital. This literature review provides an overview of the central nervous system (CNS) manifestations of major autoimmune rheumatic disorders, which may include parenchymal brain and meningeal disease (stroke, meningoencephalitis, meningitis), myelopathies, psychosis, chorea, seizure disorders, and various forms of cephalea. Novel findings linking specific autoimmune markers to CNS damage reveal a direct, previously underestimated link between systemic inflammation and neural injury. Besides, with the increasing use of biological therapies, it is crucial to recognize when neurological manifestations are related to adverse events of therapy, as this may significantly influence treatment decisions. Neurologists play a key role in this assessment, working closely with rheumatologists. Overall, addressing CNS involvement in rheumatic diseases is important for improving patient outcomes and advancing medical knowledge in this complex field. A thorough understanding of the neurologic aspects of rheumatic diseases is essential for optimal patient care, necessitating a multidisciplinary approach to management.

摘要

随着神经科医生在管理风湿性疾病患者中的作用不断扩大,风湿科医生和神经科医生之间的合作变得越来越重要。本文综述了主要自身免疫性风湿性疾病的中枢神经系统(CNS)表现,这些疾病可能包括实质脑和脑膜疾病(中风、脑膜脑炎、脑膜炎)、脊髓病、精神病、舞蹈病、癫痫发作障碍和各种形式的头痛。将特定自身免疫标志物与 CNS 损伤联系起来的新发现揭示了系统性炎症与神经损伤之间的直接、以前被低估的联系。此外,随着生物治疗的应用越来越广泛,识别神经表现与治疗相关的不良反应至关重要,因为这可能会显著影响治疗决策。神经科医生在这方面的评估中发挥着关键作用,与风湿科医生密切合作。总之,风湿性疾病的 CNS 受累问题对于改善患者预后和推进这一复杂领域的医学知识至关重要。全面了解风湿性疾病的神经学方面对于提供最佳的患者护理至关重要,这需要采用多学科方法进行管理。

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