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The MRZ reaction helps to distinguish rheumatologic disorders with central nervous involvement from multiple
Tilman Hottenrott1, Rick Dersch2, Benjamin Berger2
1Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany. tilman.hottenrott@uniklinik-freiburg.de.
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.
Insights
The MRZ reaction (MRZR) is a valuable tool for differentiating multiple sclerosis (MS) from other neurological disorders. MRZR-2 shows high specificity for MS, aiding in accurate diagnosis.
Area of Science:
- Neurology
- Immunology
- Clinical Diagnostics
Background:
- Central nervous system (CNS) involvement can mimic multiple sclerosis (MS) in rheumatologic disorders.
- The MRZ reaction (MRZR), measuring antibodies against measles, rubella, and varicella zoster viruses, is often positive in MS.
- Its utility in distinguishing MS from CNS manifestations of rheumatologic disorders (RDwCNS) is not well-established.
Purpose of the Study:
- To evaluate the diagnostic performance of the MRZ reaction (MRZR) in differentiating multiple sclerosis (MS) from rheumatologic disorders with CNS involvement (RDwCNS).
- To assess the MRZR's ability to distinguish MS from other inflammatory autoimmune neurological diseases (OIND).
Main Methods:
- The MRZR was assessed in three patient groups: RDwCNS (n=23), MS (n=46), and OIND (n=48).
- Two stringency levels were applied: MRZR-1 (≥1 positive antibody index) and MRZR-2 (≥2 positive antibody indices).
Main Results:
- No significant difference in positive MRZR prevalence was found between RDwCNS and OIND groups.
- The MS group showed significantly higher positive MRZR prevalence (MRZR-1: 82.6%, MRZR-2: 63.0%) compared to RDwCNS and OIND groups (p<0.005).
Conclusions:
- The MRZ reaction, particularly MRZR-2, demonstrates high specificity for multiple sclerosis.
- MRZR-2 can serve as a valuable diagnostic aid for differentiating MS from RDwCNS and OIND.
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