Abstract
BackgroundSome rheumatologic disorders may initially manifest with central nervous system (CNS) affection, mimicking the clinical, magnetic resonance imaging, and cerebrospinal fluid findings of multiple sclerosis (MS). The MRZ reaction (MRZR), composed of the three respective antibody indices (AIs) against measles, rubella, and varicella zoster virus, has been found positive frequently in MS patients. However, it is unclear whether the MRZR is helpful to distinguish rheumatologic disorders with CNS involvement (RDwCNS) from MS.MethodsThe MRZR was evaluated in patients with RDwCNS (n = 23), MS (n = 46; age and sex matched to patients with RDwCNS), and other inflammatory autoimmune neurological diseases affecting the CNS (OIND; n = 48). Both the stringency levels that have been used in previous MRZR studies, MRZR-1 (≥ 1 of 3 AIs positive) and MRZR-2 (≥ 2 of 3 AIs positive), were applied.ResultsThere was no statistically significant difference in the prevalence of positive MRZR between patients with RDwCNS (MRZR-1: 13.0% and MRZR-2: 8.7%, respectively) and OIND (MRZR-1: 22.9% and MRZR-2: 8.3%, respectively). Compared to these two study cohorts, the MS group exhibited significantly higher prevalences of positive MRZR (MRZR-1: 82.6%, MRZR-2: 63.0%; p < 0.005 each).ConclusionsConsidering the high specificity of MRZR-2 for MS found in this study, MRZR-2 can be a useful diagnostic tool for distinguishing MS from RDwCNS or OIND.
Highlights
Some rheumatologic disorders may initially manifest with central nervous system (CNS) affection, mimicking the clinical, magnetic resonance imaging, and cerebrospinal fluid findings of multiple sclerosis (MS)
CNS involvement of rheumatologic disorders with CNS involvement (RDwCNS) was defined on the basis of clinical signs such as headache, neuropsychological disturbances or focal neurological disturbances, and the presence of either of the following two paraclinical findings: (1) inflammatory changes in the cerebrospinal fluid (CSF), such as elevated cell count, intrathecal immunoglobulin synthesis, positive oligoclonal bands (OCB), or significant disturbance in the blood-CSF barrier indicated by an age-related elevation in the albumin quotient or (2) inflammatory signs in brain or spinal magnetic resonance imaging (MRI) compatible with RDwCNS as assessed by neuroradiologists of the University Medical - Centre Freiburg
Study population Fifty patients diagnosed with RDwCNS were retrospectively screened to confirm the diagnosis and for the availability of sufficient clinical, CSF, and MRI data as well as adequate CSF/serum samples for the determination of MRZ reaction (MRZR)
Summary
Some rheumatologic disorders may initially manifest with central nervous system (CNS) affection, mimicking the clinical, magnetic resonance imaging, and cerebrospinal fluid findings of multiple sclerosis (MS). The MRZ reaction (MRZR), composed of the three respective antibody indices (AIs) against measles, rubella, and varicella zoster virus, has been found positive frequently in MS patients It is unclear whether the MRZR is helpful to distinguish rheumatologic disorders with CNS involvement (RDwCNS) from MS. Some rheumatologic disorders may initially present with central nervous system (CNS) involvement, mimicking the clinical, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) findings of multiple sclerosis (MS). The intrathecal synthesis of antibodies and the migration of T cells, B cells, macrophages, and monocytes across the blood-brain barrier into the CNS were observed [1] These mechanisms potentially result in CSF alterations (mild pleocytosis in Hottenrott et al BMC Neurology (2018) 18:14
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