Rheumatologic diseases can initially present as neurological disorders, delay diagnosis for many months

Loyola University Health SystemAug 19 2014

Lupus and other rheumatologic diseases can initially present as neurological disorders such as headaches and seizures, and thus delay diagnosis for many months, according to Loyola University Medical Center neurologists.

Moreover, treatments for rheumatologic disorders can cause adverse neurological effects, Dr. Sean Ruland and colleagues report in the journal Current Neurology and Neuroscience Reports.

Rheumatologic diseases include autoimmune and inflammatory disorders of the joints and soft tissues, such as lupus, systemic vasculitis and ankylosing spondylosis.

Lupus can cause heart problems that lead to strokes. More than half of lupus patients suffer headaches, and a third suffer migraines. About 1.5 percent experience "lupus headache," defined as a persistent, severe and intractable headache that does not respond to narcotic medications. As many as 20 percent experience seizures, and a third experience cognitive dysfunction. As many as 20 percent of lupus patients experience mood disorders. Lupus psychosis, which can include paranoia and hearing voices, can be confused with schizophrenia.

Patients with systemic vasculitis can experience neurologic disorders such as headaches, seizures, stroke-like syndromes and optic neuropathies. A third will have residual neurological impairments and will require long-term treatment to suppress their immune systems.

Ankylosing spondylosis patients can experience headaches, cerebellar and brainstem dysfunction, cognitive impairments, seizures and cranial neuropathy.

"Rheumatic disorders presenting as neurological syndromes may pose diagnostic challenges," Ruland and colleagues write.

Medications for patients with rheumatic disorders include immune-suppressing drugs and non-steroidal anti-inflammatory drugs. New medications have expanded treatment options. "However, these treatments also carry a risk of adverse neurological effects," Ruland and colleagues write. "Therefore, familiarity with neurological manifestations of rheumatologic diseases, diagnosis and potential nervous system consequences of treatment is paramount."