Rheumatologic diseases such as lupus and ankylosing spondylosis can initially look like neurological disorders, delaying diagnosis

Some rheumatologic diseases (such as lupus, systemic vasculitis and ankylosing spondylosis) can initially seem to be neurological disorders (such as headaches and seizures) and this can delay diagnosis for many months, says research published in Current Neurology and Neuroscience Reports.
The experts involved also found that rheumatologic disorders can cause adverse neurological effects.
“Rheumatic disorders presenting as neurological syndromes may pose diagnostic challenges,” explains Dr Sean Ruland and colleagues, outlining the following in their research:

• Lupus. More than half of people with lupus experience headaches, and one-third suffer migraines. About 1.5% have “lupus headache,” a persistent and severe headache that does not respond to narcotic medications. As many as 20% have seizures, and a third experience cognitive dysfunction. Up to 20% of people with lupus experience mood disorders. Lupus psychosis, which can include paranoia and hearing voices, can be confused with schizophrenia.
• Systemic vasculitis. People with systemic vasculitis can experience neurologic disorders such as headaches, seizures, stroke-like syndromes and optic neuropathies. One-third may have residual neurological impairments and will require long-term treatment to suppress their immune systems.
• Ankylosing spondylosis. Those with ankylosing spondylosis can experience headaches, cerebellar and brainstem dysfunction, cognitive impairments, seizures and cranial neuropathy.

Medication for people with rheumatic disorders include immune-suppressing drugs and non-steroidal anti-inflammatory drugs. New medications have expanded treatment options but some of these have adverse effects.
“These treatments also carry a risk of adverse neurological effects,” Dr Ruland explains. “Therefore, familiarity with neurological manifestations of rheumatologic diseases, diagnosis and potential nervous system consequences of treatment is paramount.”

Photo credit: Vic