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. 2018 Jan 31;18(1):14.
doi: 10.1186/s12883-018-1018-3.

The MRZ reaction helps to distinguish rheumatologic disorders with central nervous involvement from multiple sclerosis

Tilman Hottenrott  1 , Rick Dersch  2 , Benjamin Berger  2 , Dominique Endres  3 , Daniela Huzly  4 , Jens Thiel  5 , Sebastian Rauer  2 , Oliver Stich  2 , Ulrich Salzer  5 , Nils Venhoff  5
Affiliations

The MRZ reaction helps to distinguish rheumatologic disorders with central nervous involvement from multiple sclerosis

Tilman Hottenrott et al. BMC Neurol. .

Abstract

Background: 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. However, it is unclear whether the MRZR is helpful to distinguish rheumatologic disorders with CNS involvement (RDwCNS) from MS.

Methods: The 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.

Results: There 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).

Conclusions: Considering 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.

Keywords: ANCA-associated vasculitides; Behçet’s disease; Intrathecal polyspecific antiviral immune response; MRZ reaction (MRZR); Multiple sclerosis (MS); Neuropsychiatric systemic lupus erythematosus (NPSLE).

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Conflict of interest statement

Authors’ information

All authors are physicians working at the Medical Center - University Freiburg, Germany. TH, RD, DE and US are resident physicians; BB is a consultant physician. DH is a senior physician at the Institute of Virology. SR is the chief physician at the Department of Neurology and Neurophysiology. OS is a senior physician at the Department of Neurology and Neurophysiology. JT and NV are senior physicians at the Department of Rheumatology and Clinical Immunology.

Consent for publication

Not applicable.

Competing interests

TH received travel grants from Bayer Vital GmbH and Novartis. RD, DE, and US report no conflicts of interest for this study. BB received travel grants and/or training expenses from Bayer Vital GmbH, Ipsen Pharma GmbH, Norvartis, and Genzyme, as well as lecture fees from Ipsen Pharma GmbH. DH received lecture fees from Serion. OS and SR report receiving consulting and lecture fees, grant, and research support from Baxter, Bayer Vital GmbH, Biogen Idec, Genzyme, Merck Serono, Novartis, RG, Sanofi-Aventis, and Teva. SR indicates that he is a founding executive board member of ravo Diagnostika GmbH (Oltmannsstrasse 5, D-79100 Freiburg, Germany), which sells in-vitro diagnostic medical devices for the detection of infectious diseases and paraneoplastic autoantibodies. JT and NV have served on the advisory boards of, have participated in lectures for, and/or received research or travel grants from AbbVie, GSK, Janssen-Cilag, Lilly, Medac, Novartis, Pfizer, and Roche.

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Figures

Fig. 1
Fig. 1
Frequency of positive MRZR-1 (≥ 1 positive AI) and MRZR-2 (≥ 2 positive AIs) in patients with rheumatologic disorders with involvement of the central nervous system (RDwCNS), multiple sclerosis (MS), and other inflammatory autoimmune neurological diseases (OIND; [17])
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