Younger woman with headache

September 19, 2021

Read for 3 minutes

Source / information

Published by:

Source:

Disclosure:
Merrill JT. Current concepts on the pathogenesis and management of neuropsychiatric SLE. Presented at: Congress of Clinical Rheumatology-West annual symposium; 18.-21. September 2021 (hybrid meeting). Merrill reports consulting fees from AbbVie, Alpine, Alexion, Amgen, Astellas, Astra Zeneca, Aurinia, Celgene / BMS, Daitchi Sanyo, Eli Lilly, EMD Serono, GlaxoSmithKline, Immunpharma, Janssen, Remegen, Servier / ILTOO, Resolve and Provention UCB, as well Lecture fees from AbbVie and Celgene / BMS and research grants from GlaxoSmithKline and Celgene / BMS.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact [email protected]

Back to Healio

Joan T. Merrill

Although patients with neuropsychiatric manifestations of systemic lupus erythematosus may have a variety of rare manifestations, these symptoms are not necessarily specific to lupus, according to a speaker here.

“I don’t think I have to prove to anyone in this room that patients with lupus are diverse.” Joan T. Merrill, MD, Director of clinical projects in the Arthritis & Clinical Immunology program of the Oklahoma Medical Research Foundation, told attendees at the Clinical Rheumatology 2021-West Congress. “Even when we try to focus on neuropsychiatric symptoms – which are quite rare in lupus – there is an immense variety of reports. In fact, there are 19 syndromes that the ACR calls “CNS lupus”. This is what we are faced with: a very diverse population. ”

Younger woman with a headache

“Almost any of the manifestations we see in lupus can be found alone in people with no other manifestations of lupus, and not infrequently in related disorders,” Joan T. Merrill, MD told participants. “We can’t always tell from the symptoms, not always from the diagnostic work-up, and sometimes the boundaries between these syndromes are very blurred.” Source: Adobe Stock

“On the other hand, people with lupus are not unique and almost any of the manifestations we see in lupus can be found on their own in people with no other manifestations of lupus and are not infrequently found in related diseases,” she added. “To make matters worse, the presentation features and even some of the diagnostic results that we get when working through these patients are very overlapping. We cannot always tell from the symptoms, not always from the diagnostic work-up, and in some cases the boundaries between these syndromes are very blurred. “

“Lupus headache” has long been a stereotypical neuropsychiatric manifestation and remains a disease-related entity in the Systemic Lupus Erythematosus Disease Activity Index. However, due to the lack of a detailed definition, it continued to be debated whether this is a valid neuropsychiatric symptom of lupus. For Merrill, this is not a worthwhile debate.

“I’m here to tell you guys that there is no such thing as a lupus headache, which we have been saying for years,” she told participants. “I think what happened was that sometime between when people thought there was lupus headaches and now we developed much better treatments for classic migraines and all of those lupus headaches went away.”

The most commonly reported neuropsychiatric syndromes in lupus patients include headache, cognitive, anxiety, and depression. However, Merrill noted that these “are rarely caused by lupus, but all of them are on the list because someone will present themselves that way every now and then”.

In the case of a headache, Merrill said it “probably wasn’t from lupus,” but it could be a sign of meningitis, pseudotumor, or cranial neuropathy. “But these syndromes tend to be more complex, so you are pretty unlikely to think that an isolated headache is not due to lupus,” she said.

Another common syndrome is cognitive dysfunction – “again, usually not due to lupus”. However, Merrill noted that a “big exception” to this is multi-infarct dementia, a common cause of memory loss in the elderly that has been seen in patients with antiphospholipid syndrome.

“It’s very sad because it starts insidiously, slowly, and you could say it’s lupus or microthrombi, but you definitely want to see it in the context of lupus,” Merrill said. “You want to take into account the age of the patient, whether they are very tired, which of course is one of the most common complaints for those with lupus; It’s a very stressful disease. It can certainly affect your ability to concentrate. ”

Doctors should also rule out whether patients have a mood disorder, a cardiovascular risk factor, and whether these symptoms could be due to thyroid disease.

“Anxiety syndromes are usually situational or unrelated to lupus, but can always be part of a complex SLE-related syndrome,” Merrill said. “I think you want to think about these things: is this isolated or am I seeing something else here? If you rule out something else, assume that it is probably not due to lupus. The same goes for depression, as it is usually not related to an SLE flare. “

Aside from lupus, there are several other possible causes of certain neuropsychiatric syndromes that clinicians may not be familiar with, according to Merrill.

“For example, when there is a seizure, it is very difficult to find out what caused it,” she said. “It could be diffuse CNS lupus, it could be encephalitis, it could be due to vasculitis, or it could be due to antiphospholipid syndromes which have been reported several times in the literature. Seizures are very difficult to find out. “

Cerebrovascular disease, on the other hand, “as soon as we diagnose it, is usually due to vasculitis or antiphospholipid syndrome”.

Merrill noted that an “acute state of confusion” could be diffuse generalized encephalitis, CNS lupus, “or it could easily be vasculitis, but again, it would not normally appear on its own without something else suggesting vasculitis . “

Finally, myelopathy and demyelinating syndrome could also be potential causes of neuropsychiatric syndromes in neuromyelitis optica spectrum disorders, often associated with lupus, Sjogren’s syndrome, and antiphospholipid syndrome.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact [email protected]

Back to Healio

Congress for Clinical Rheumatology Annual Meeting

Congress for Clinical Rheumatology Annual Meeting