В статье впервые в России описан случай успешного применения анти-В-клеточной терапии ритуксимабом у пациентки с болезнью Шегрена (БШ) и оптикомиелит-ассоциированным расстройством (ОАР). Приведены данные литературы по клиническим проявлениям и методам диагностики ОАР. Представлены современные взгляды на патогенез сочетания данного заболеваний с БШ.
This case is the first description of the successful anti-B-cell therapy with rituximab in a patient with Sjogrenʼs syndrome and neuromyelitis optica spectrum disorder in Russia. This article contains the literature data on clinical manifestations and methods of the diagnosis of neuromyelitis optica spectrum disorder. Furthermore, contemporary view on the pathogenesis of the combination of this disease with Sjogrenʼs syndrome are presented here.
1. Васильев В.И., Грачев Ю.В., Никитин С.С. Поражение периферической и центральной нервной системы при болезни Шегрена. Клинические и теоретические аспекты боли. М.: Издательство РУДН, 2001.[Vasiliev VI, Grachev UV, Nikitin SS. Porazhenie perifericheskoi i tsentralʼnoi nervnoi sistemy pri bolezni shegrena. klinicheskie i teoreticheskie aspekty boly. Moscow: RUDN Press; 2001. (In Russ.)].
2. Chai J, Logigian EL. Neurological manifestations of primary Sjögren’s syndrome. Curr Opin Neurol. 2010; 23: 509-13. http://doi.org/10. 1097/WCO.0b013e32833de6ab
3. Сафонова Т.Н., Васильев В.И., Лихванцева В.Г. Синдром Шегрена: руководство для врачей. М.: Издательство Московского университета; 2013.[Safonova TN, Vasiliev VI, Likhvantseva VG. Sindrom Shegrena: rukovodstvo dlya vrachei. Moscow: Moscow University Press; 2013. (In Russ.)].
4. Massara A, Bonazza S, Castellino G et al. Central nervous system involvement in Sjogren’s syndrome: Unusual, but not unremarkable–clinical, serological characteristics and outcomes in a large cohort of Italian patients. Rheumatology. 2010; 49(8): 1540-1549. https://doi.org/10.1093/rheumatology/keq111
5. Vincent TL, Richardson MP, Mackworth-Young CG, Hawke, Venables PJW. Sjogren’s syndrome-associated myelopathy: response to immunosuppressive treatment. Am J Med. 2003; 114:145-8. https://doi.org/10.1016/S0002-9343(02)01380-3
6. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF and Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology. 2006; 66: 1485-1489. http://doi.org/10.1212/01.wnl. 0000216139. 44259.74
7. Akaishi T, Nakashima I. Neuromyelitis Optica Spectrum Disorders. Neuroimaging Clin N Am. 2017 May; 27(2): 251-265. http://doi.org/ 10.1016/j.nic.2016.12.010
8. Lennon VA, Wingerchuck DM, Kryzer TJ et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004; 364: 2106-2112. http://doi.org/10.1016/S0140-6736(04) 17551-X
9. Min JH, Kim HJ, Kim BJ et al. Brain abnormalities in Sjogren syndrome with recurrent CNS manifestations: association with neuromyelitis optica. Mult Scler. 2009; 15:1069–1076. https://doi.org/ 10.1177/1352458509106228
10. Wingerchuk DM, Weinshenker BG. The emerging relationship between neuromyelitis optica and systemic rheumatologic autoimmune disease. Multiple Sclerosis J. 2012; 18(1): 5-10. https://doi.org/10. 1177/1352458511431077
11. Wandinger KP, Stangel M, Witte T, Venables P, Charles P, Jarius S et al. Autoantibodies against aquaporin-4 in patients with neuropsychiatric systemic lupus erythematosus and primary Sjogren ’ s syndrome. Arthritis Rheum. 2010; 62(4):1198-200. https://doi.org/ 10.1002/ art.27337
12. Wingerchuk DM, Weinshenker BG. Neuromyelitis optica: clinical predictors of a relapsing course and survival. Neurology. 2003; 60(5):848-53. https://doi.org/10.1212/01.WNL.0000049912.02954.2C
13. Ананьева Л.П., Соловьев С.К., Бекетова Т.В., Васильев В.И., Антелава О.А., Александрова Е.Н., Конева О.А., Цанян М.Э., Десинова О.В., Логвиненко О.А., Волков А.В., Хелковская-Сергеева А.Н., Новиков А.А., Алексанкин А.А., Насонов Е.Л. Анти-В-клеточная терапия при иммуновоспалительных ревматических заболеваниях: эффективность и переносимость у 229 больных. Научно-практическая ревматология. 2014; 52(5):495-506. [Ananieva LP, Soloviyov SK, Beketova TV, Vasiliev VI, Antelava OA, Aleksandrova EN, Koneva OA, Tsanyan ME, Desinova OV, Logvinenko OA, Volkov AV, Helkovskaya-Sergeeva AN, Novikov AA, Aleksankin AA, Nasonov YL. Anti-B-cell therapy at immune inflammatory rheumatic diseases: efficacy and tolerability in 229 patients. Rheumatology Science and Practice. 2014; 52(5):495-506. (In Russ.)]. https://doi.org/10. 14412/1995-4484-2014-495-506
14. Jahnke K, Thiel E. Treatment options for central nervous system lymphomas in immunocompetent patients. Expert Rev Neurother. 2009 Oct;9(10):1497-509. https://doi.org/10.1586/ern.09.100
15. Batchelor T, Grossman S, Mikkelsen T, Ye X, Desideri S, Lesser G. Rituximab monotherapy for patients with recurrent primary CNS lymphoma. Neurology. 2011; 76:929-930. http://doi.org/10. 1212/WNL.0b013e31820f2d94
16. Carvalho DC, Tironi TS, Freitas DS. Sjögren syndrome and neuromyelitis optica spectrumdisorder co-exist in a common autoimmune milieu. Arq Neuropsiquiatr. 2014 Aug; 72(8):619-24. http://doi.org/10. 1590/0004-282X20140097
17. Javed A, Balabanov R, Arnason BG. Minor salivary gland inflammation in Devic’s disease and longitudinally extensive myelitis. Mult Scler. 2008; 14:809-814. https://doi.org/10.1177/1352458508088941
18. Delporte C, Steinfeld S. Distribution and roles of aquaporins in salivary glands. Biochim Biophys Acta. 2006; 1758:1061-1070. https://doi.org/10.1016/j.bbamem.2006.01.022
19. Sawada J, Orimoto R et al. A case of pathology-proven neuromyelitis optica spectrum disorder with Sjögren syndrome manifesting aphasia and apraxia due to a localized cerebral white matter lesion. Multiple Sclerosis Journal. 2014; 20(10):1413-1416. https://doi.org/10. 1177/1352458514540834
20. Kim SM, Waters P, Vincent A et al. Sjögren’s syndrome myelopathy: spinal cord involvement in Sjögren’s syndrome might be a manifestation of neuromyelitis optica. Mult Scler. 2009; 15:1062-8. https://doi.org/10.1177/1352458509106636
21. Sellner J, Boggild M, Clanet M et al. EFNS guidelines on the diagnosis and management of neuromyelitis optica. Eur J Neurol. 2010; 17: 1019-1032. https://doi.org/10.1111/j.1468-1331.2010.03066.x
22. Radaelli M, Moiola L, Sangalli F, Esposito F, Barcella V, Ferre L et al. Neuromyelitis optica spectrum disorders: long-term safety and efficacy of rituximab in Caucasian patients. Mult Scler. 2016 Apr; 22(4):511-9. https://doi.org/10.1177/1352458515594042
23. Zephir H, Bernard-Valnet R, Lebrun C, Outteryck O, Audoin B, Bourre B et al. Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability. J Neurol. 2015; 262: 2329-2335. https://doi.org/10.1007/s00415-015-7852-y
24. Kim S, Kim W, Li X, Jung I and Kim H. Repeated treatment with rituximab based on the assessment of peripheral circulating memory B cells in patients with relapsing neuromyelitis optica over 2 years. Arch Neurol. 2011; 68: 1412-1420. https://doi.org/10.1001/archneurol.2011. 154
25. Mealy M, Wingerchuk D, Palace J, Greenberg B and Levy M. Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy. JAMA Neurol. 2014; 71: 324-330. https://doi.org/10.1001/jamaneurol.2013.5699
26. Ramakrishna R, Chaudhuri K, Sturgess A, Manoharan A. 1992 Haematological manifestations of primary Sjogren’s syndrome: a clinicopathological study. Q J Med. 1992; 83:547-54. https://doi.org/ 10.1016/S0031-3025(16)35939-6
27. Capsoni F, Sarzi-Puttini P, Zanella A. Primary and secondary autoimmune neutropenia. Arthritis Res Ther. 2005; 7:208-14. https://doi.org/ 10.1186/ar1803
28. Chaiwatanatorn K, Lee N, Grigg A, Filshie R, Firkin F. Delayed-onset neutropenia associated with rituximab therapy. Br J Haematol. 2003; 121(6):913-8. https://doi.org/10.1046/j.1365-2141.2003.04385.x
29. Dunleavy K, Hakim F, Kim HK, Janik JE, Grant N, Nakayama T, White T, Wright G, Kwak L, Gress R, Tosato G, Wilson WH. B-cell recovery following rituximab-based therapy is associated with perturbations in stromal derived factor-1 and granulocyte homeostasis. Blood. 2005; 106(3):795-802. https://doi.org/10.1182/blood-2004-08-3198
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1. [Vasiliev VI, Grachev UV, Nikitin SS. Porazhenie perifericheskoi i tsentralʼnoi nervnoi sistemy pri bolezni shegrena. klinicheskie i teoreticheskie aspekty boly. Moscow: RUDN Press; 2001. (In Russ.)].
2. Chai J, Logigian EL. Neurological manifestations of primary Sjögren’s syndrome. Curr Opin Neurol. 2010; 23: 509-13. http://doi.org/10. 1097/WCO.0b013e32833de6ab
3. [Safonova TN, Vasiliev VI, Likhvantseva VG. Sindrom Shegrena: rukovodstvo dlya vrachei. Moscow: Moscow University Press; 2013. (In Russ.)].
4. Massara A, Bonazza S, Castellino G et al. Central nervous system involvement in Sjogren’s syndrome: Unusual, but not unremarkable–clinical, serological characteristics and outcomes in a large cohort of Italian patients. Rheumatology. 2010; 49(8): 1540-1549. https://doi.org/10.1093/rheumatology/keq111
5. Vincent TL, Richardson MP, Mackworth-Young CG, Hawke, Venables PJW. Sjogren’s syndrome-associated myelopathy: response to immunosuppressive treatment. Am J Med. 2003; 114:145-8. https://doi.org/10.1016/S0002-9343(02)01380-3
6. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF and Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology. 2006; 66: 1485-1489. http://doi.org/10.1212/01.wnl. 0000216139. 44259.74
7. Akaishi T, Nakashima I. Neuromyelitis Optica Spectrum Disorders. Neuroimaging Clin N Am. 2017 May; 27(2): 251-265. http://doi.org/ 10.1016/j.nic.2016.12.010
8. Lennon VA, Wingerchuck DM, Kryzer TJ et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004; 364: 2106-2112. http://doi.org/10.1016/S0140-6736(04) 17551-X
9. Min JH, Kim HJ, Kim BJ et al. Brain abnormalities in Sjogren syndrome with recurrent CNS manifestations: association with neuromyelitis optica. Mult Scler. 2009; 15:1069–1076. https://doi.org/ 10.1177/1352458509106228
10. Wingerchuk DM, Weinshenker BG. The emerging relationship between neuromyelitis optica and systemic rheumatologic autoimmune disease. Multiple Sclerosis J. 2012; 18(1): 5-10. https://doi.org/10. 1177/1352458511431077
11. Wandinger KP, Stangel M, Witte T, Venables P, Charles P, Jarius S et al. Autoantibodies against aquaporin-4 in patients with neuropsychiatric systemic lupus erythematosus and primary Sjogren ’ s syndrome. Arthritis Rheum. 2010; 62(4):1198-200. https://doi.org/ 10.1002/ art.27337
12. Wingerchuk DM, Weinshenker BG. Neuromyelitis optica: clinical predictors of a relapsing course and survival. Neurology. 2003; 60(5):848-53. https://doi.org/10.1212/01.WNL.0000049912.02954.2C
13. [Ananieva LP, Soloviyov SK, Beketova TV, Vasiliev VI, Antelava OA, Aleksandrova EN, Koneva OA, Tsanyan ME, Desinova OV, Logvinenko OA, Volkov AV, Helkovskaya-Sergeeva AN, Novikov AA, Aleksankin AA, Nasonov YL. Anti-B-cell therapy at immune inflammatory rheumatic diseases: efficacy and tolerability in 229 patients. Rheumatology Science and Practice. 2014; 52(5):495-506. (In Russ.)]. https://doi.org/10. 14412/1995-4484-2014-495-506
14. Jahnke K, Thiel E. Treatment options for central nervous system lymphomas in immunocompetent patients. Expert Rev Neurother. 2009 Oct;9(10):1497-509. https://doi.org/10.1586/ern.09.100
15. Batchelor T, Grossman S, Mikkelsen T, Ye X, Desideri S, Lesser G. Rituximab monotherapy for patients with recurrent primary CNS lymphoma. Neurology. 2011; 76:929-930. http://doi.org/10. 1212/WNL.0b013e31820f2d94
16. Carvalho DC, Tironi TS, Freitas DS. Sjögren syndrome and neuromyelitis optica spectrumdisorder co-exist in a common autoimmune milieu. Arq Neuropsiquiatr. 2014 Aug; 72(8):619-24. http://doi.org/10. 1590/0004-282X20140097
17. Javed A, Balabanov R, Arnason BG. Minor salivary gland inflammation in Devic’s disease and longitudinally extensive myelitis. Mult Scler. 2008; 14:809-814. https://doi.org/10.1177/1352458508088941
18. Delporte C, Steinfeld S. Distribution and roles of aquaporins in salivary glands. Biochim Biophys Acta. 2006; 1758:1061-1070. https://doi.org/10.1016/j.bbamem.2006.01.022
19. Sawada J, Orimoto R et al. A case of pathology-proven neuromyelitis optica spectrum disorder with Sjögren syndrome manifesting aphasia and apraxia due to a localized cerebral white matter lesion. Multiple Sclerosis Journal. 2014; 20(10):1413-1416. https://doi.org/10. 1177/1352458514540834
20. Kim SM, Waters P, Vincent A et al. Sjögren’s syndrome myelopathy: spinal cord involvement in Sjögren’s syndrome might be a manifestation of neuromyelitis optica. Mult Scler. 2009; 15:1062-8. https://doi.org/10.1177/1352458509106636
21. Sellner J, Boggild M, Clanet M et al. EFNS guidelines on the diagnosis and management of neuromyelitis optica. Eur J Neurol. 2010; 17: 1019-1032. https://doi.org/10.1111/j.1468-1331.2010.03066.x
22. Radaelli M, Moiola L, Sangalli F, Esposito F, Barcella V, Ferre L et al. Neuromyelitis optica spectrum disorders: long-term safety and efficacy of rituximab in Caucasian patients. Mult Scler. 2016 Apr; 22(4):511-9. https://doi.org/10.1177/1352458515594042
23. Zephir H, Bernard-Valnet R, Lebrun C, Outteryck O, Audoin B, Bourre B et al. Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability. J Neurol. 2015; 262: 2329-2335. https://doi.org/10.1007/s00415-015-7852-y
24. Kim S, Kim W, Li X, Jung I and Kim H. Repeated treatment with rituximab based on the assessment of peripheral circulating memory B cells in patients with relapsing neuromyelitis optica over 2 years. Arch Neurol. 2011; 68: 1412-1420. https://doi.org/10.1001/archneurol.2011. 154
25. Mealy M, Wingerchuk D, Palace J, Greenberg B and Levy M. Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy. JAMA Neurol. 2014; 71: 324-330. https://doi.org/10.1001/jamaneurol.2013.5699
26. Ramakrishna R, Chaudhuri K, Sturgess A, Manoharan A. 1992 Haematological manifestations of primary Sjogren’s syndrome: a clinicopathological study. Q J Med. 1992; 83:547-54. https://doi.org/ 10.1016/S0031-3025(16)35939-6
27. Capsoni F, Sarzi-Puttini P, Zanella A. Primary and secondary autoimmune neutropenia. Arthritis Res Ther. 2005; 7:208-14. https://doi.org/ 10.1186/ar1803
28. Chaiwatanatorn K, Lee N, Grigg A, Filshie R, Firkin F. Delayed-onset neutropenia associated with rituximab therapy. Br J Haematol. 2003; 121(6):913-8. https://doi.org/10.1046/j.1365-2141.2003.04385.x
29. Dunleavy K, Hakim F, Kim HK, Janik JE, Grant N, Nakayama T, White T, Wright G, Kwak L, Gress R, Tosato G, Wilson WH. B-cell recovery following rituximab-based therapy is associated with perturbations in stromal derived factor-1 and granulocyte homeostasis. Blood. 2005; 106(3):795-802. https://doi.org/10.1182/blood-2004-08-3198
Авторы
А.В. Торгашина, В.И. Васильев
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия
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A.V. TORGASHINA, V.I. VASILYEV
V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia