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AUTOIMMUNE ASPECTS OF ARACHNOIDITIS

AUTOIMMUNE ASPECTS OF ARACHNOIDITIS

Whilst there have been individual doctors who suspect an autoimmune component to arachnoiditis, there has been little specific research into this. The following ideas are like pieces of a jigsaw and may be difficult to put together to form a picture, as many of the pieces of the puzzle remain missing. I am merely attempting to note the following as pointers towards possible future areas for research.

Arachnoiditis is chronic inflammation of the arachnoid layer of the meninges, resulting in formation of scar tissue that causes nerve roots to adhere to each other and the dural layer.

Usually this is limited by the fibrinolytic process, which breaks down excess scar tissue, but in arachnoiditis the scar tissue continues to form.

Authors such as Jayson have suggested that there may be a defect in the fibrinolytic pathway.

Dr. Frank Mayfield felt that there might be an immune response that is responsible for the degree of reaction, especially to chemical insult.

Frank and his colleagues cultured arachnoidal cells in vitro and demonstrated their immune capabilities. ([ii])

There seems, from anecdotal evidence, to be a significant proportion of arachnoiditis patients who have autoimune problems. In some cases, the autoimmune features were present before the event that triggered arachnoiditis (e.g. surgery or myelogram) which suggests an underlying predisposition. In many other cases, the autoimmune disorders were diagnosed after onset of arachnoiditis, pointing to an autoimmune reaction, probably to chemical insult such as myelographic dye. ( similar in essence to the neuropathy caused by adulterated rapeseed oil).

It may therefore be that arachnoiditis involves a non-organ specific autoimmune response, or that it is part of a multiple autoimmune syndrome.

Marinac ([iii]) noted that there appears to be an association between the occurrence of hypersensitivity-type reactions in drug and chemical induced meningitis (an acute reaction) and underlying collagen vascular disease (known to be autoimmune).

In a similar way, it is may be that arachnoiditis represents a chronic hypersensitivity and it may also be related to underlying collagen vascular diseases.

Chemically Induced Immune System Disorder (CIISD) was described by the National Foundation For the Chemically Hypersensitive as a complex multisystem condition, resulting from toxic exposure which causes development of abnormal activated immune system and thence development of autoantibodies.

Arachnoiditis may well be an example of CIISD.

THE LINK BETWEEN ARACHNOIDITIS AND OTHER AUTOIMMUNE DISORDERS

It has been seen in conditions such as Rheumatoid Arthritis that there may be anti-plasminogen antibodies (plasminogen is part of the fibrinolytic pathway).

It may therefore be possible that arachnoiditis involves an autoimmune process that affects fibrinolysis.

A recent paper([iv]) suggests that there is a similar process of inflammation to that seen in serous membranes such as the peritoneum, with “a negligible inflammatory cellular exudate and a prominent fibrinous exudate”. It is worth noting that the condition retroperitoneal fibrosis may be seen in association with rheumatoid arthritis.

There are also other autoimmune diseases such as scleroderma, in which fibrosis is a feature. By studying these conditions, we may be able to increase our understanding of arachnoiditis.

It is worth noting that a number of arachnoiditis patients develop multiple drug allergies. This is also a feature of autoimmune diseases such as lupus.

Another interesting point is that there is a link emerging between viral infections such as mononucleosis (Epstein Barr virus) and autoimmune disorders such as Sjogren’s disease, Systemic Lupus and MS. A number of arachnoiditis patients, either with or without diagnosed autoimmune disease, have also had preceding viral infection, maybe even some years prior to onset of arachnoiditis. It is now being postulated that these viruses may act as a trigger for...

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