Lupus and symptoms of nervous system involvement
Posted On April 3, 2021
Studies revealed that systemic lupus erythematosus may affect the nervous system. Lupus patients may experience confusion, difficulty concentrating, headaches, fatigue, strokes, or other signs that show nervous system involvement.
Studies suggested that nerve tissue can be damaged when antibodies attack nerve cells or blood vessels. The nervous system is known to require uninterrupted blood flow, which is necessary to supply oxygen and nutrients to its tissues. When this blood flow is slowed or interrupted, nerve cells cannot function normally and symptoms appear. Symptoms vary, depending on where the tissue injury is located. The central nervous system included the brain and spinal cord, the nerve fibers of the peripheral nervous system that have the function of providing the skin and muscles with the necessary power for sensation and movement, and the third part is the autonomic nervous system. which has the function of regulating. spinal and peripheral nerves and to innervate internal organs.
An inflammation of the blood vessels in the brain that occurs in 10% of all lupus patients is called central nervous system vasculitis. Some of the symptoms that appear are high fever, seizures, psychosis, and a stiff neck similar to meningitis. If not treated aggressively, central nervous system vasculitis rapidly progresses to stupor and coma.
People with mild to moderate systemic lupus erythematosus may experience cognitive dysfunction. This is a group of symptoms that appear in approximately 50% of these patients, and we can mention here fatigue, memory impairment, feelings of confusion and difficulty expressing thoughts. By performing a neuropsychological test or a test called a positron emission tomography scan, these symptoms can be clearly documented. It is known that cognitive dysfunction can come and go on its own, but there is no optimal therapy available. Also, the reason for the symptoms that appear is unknown. Coping with cognitive dysfunction is frustrating, and coaching a person to develop coping skills can often be helpful.
Approximately 20% of patients with systemic lupus erythematosus experience lupus headache. This is manifested by severe headaches, is similar to migraine, and can often be seen in people who also have Raynaud’s phenomenon. As a treatment, the same that is used in tension or migraine headaches, and sometimes corticosteroids, is useful.
It is known that about a third of patients who have lupus may have a false positive syphilis test, a positive anticardiolipin antibody test, or a prolonged clotting time test. About 1/9 of patients with lupus will develop blood clots in various parts of the body, which is called antiphospholipid syndrome, the appearance of neurological deficits without any signs of active lupus. We can mention here low-dose aspirin, coumadin or heparin.
Among patients with systemic lupus erythematosus, there is a 20% percentage who also have fibromyalgia syndrome. These patients experience increased soft tissue pain, tender points, and additionally cognitive dysfunction, decreased ability to concentrate, lack of stamina, and difficulty sleeping. As treatment, we can mention antidepressants, counseling and physical therapy if necessary.
Medications used to treat systemic lupus erythematosus have been found to develop symptoms like central nervous system lupus. headache, dizziness and, in rare cases, non-steroidal anti-inflammatory drugs can cause symptoms similar to meningitis. In addition, if a patient uses corticosteroids, mood swings, psychosis, depression, agitation, confusion may appear, if high doses are taken, seizures may appear, and antihypertensive medications may be associated with depression or loss of libido.
One study found that people who have lupus and Sjogren’s syndrome may be predisposed to developing vasculitis or cognitive dysfunction. Sometimes circulating proteins in the blood can cause cryoglobulinemia or hyperviscosity syndrome. Plasmapheresis or blood filtering can alleviate these complications. Sometimes a pronounced decrease in platelet count can be associated with bleeding. People with thrombotic thrombocytopenic purpura or who lack protein S or protein. C can clot, and people with lupus, idiopathic thrombocytopenic purpura, and kidney failure can bleed.
In peripheral nervous system lupus, cranial nerve involvement can cause visual disturbances, drooping eyelid (s), ringing in the ear (s), facial pain, and dizziness. Symptoms of numbness or tingling in the arms or legs may appear if there is an inflammation of the blood vessels supplying the peripheral nerves. Symptoms may also appear due to conditions other than lupus, and the electromyogram and nerve conduction tests are often helpful in determining whether the symptoms are due to some other cause. Corticosteroids are used to treat inflammation of the peripheral nerves.
It is important for your doctor to know if you experience nervous system symptoms. These symptoms may appear due to lupus, a medication, or a particular aspect of your life. The doctor will ask about the symptoms you are experiencing, perform a physical exam and a laboratory evaluation that includes a blood chemistry panel, complete blood count, and urinalysis. Additionally, diagnostic tests such as sedimentation rate, ANAs, anti-DNA, anti-ribosomal P antibodies, and complement may be helpful in determining nervous system involvement. Neurodiagnostic tests are available, including CT scans and brain MRIs, brain waves, or EEG, and lumbar punctures. Positron emission scans can also be done in some hospitals. In patients with cognitive dysfunction, neuropsychological tests can be helpful.
Treatment for nervous system lupus depends on its origin and may include immunosuppressants, blood thinners, antibiotics, steroids, antidepressants, counseling, or surgery. If there are obvious diagnostic difficulties, a rheumatologist and / or neurologist should be involved in your care. It was found that for many people with lupus, the nervous system involvement is completely reversible.