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Rheumatologic diseases like lupus can initially look like neurological disorders

Can delay diagnosis for many months

MAYWOOD, Ill. (Aug. 18, 2014) –  The initial symptoms of lupus and other rheumatologic diseases sometimes appear to be neurological in nature, with patients experiencing  headaches and seizures, which can delay a 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 his 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.”

Ruland, senior author of the article, is an associate professor in the Department of Neurology of Loyola University Chicago Stritch School of Medicine. Other authors are Dr. Amre Nouh (first author), who completed a stroke fellowship at Loyola and now is at the University of Connecticut; and Dr. Olimpia Carbunar of Cleveland Clinic Florida.

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

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