Links Between Rheumatic And Neuropathic Disorders

Today's post from healio.com (see link below) looks again at the difficulties of correct diagnosis when it comes to neuropathy. Normally, if a person has a rheumatic disorder as their primary problem, it's not difficult to diagnose a neuropathic problem alongside that. However, if the person's primary problem is neuropathy, it's much more difficult to establish whether there are also concurrent rheumatic problems - the one complicates the diagnosis of the other. More than that, the medications used to treat either or both may interfere with the treatment of the other. It would be so much easier if everybody just had one problem to deal with but of course that's not realistic and it looks as though doctors are going to have to look much more closely at a patient's general medical history to establish the right diagnosis and then prescribe the right treatment.
 

Neurological symptoms may complicate rheumatic disorder diagnosis
Nouh A. Curr Neur Neurosci Rep. 2014; doi:10.1007/s11910-014-0456-6.
August 27, 2014

Patients with undiagnosed rheumatic conditions may present symptoms of neurological diseases, creating challenges in making an appropriate diagnosis, according to data published in Current Neurology and Neuroscience Reports.

The article outlines neurological symptoms associated with rheumatic disorders to aid in diagnosis, and highlights possible neurological complications of common treatment options.

Some of the disorders and related neurological symptoms included are:
Systemic lupus erythematosus: Patients may present neurological symptoms such as headaches, which occur in over half of all patients with systemic lupus erythematosus, or seizures, which occur in about 11% to 20% of patients.

Peripheral nervous systems symptoms may include peripheral neuropathy, plexopathy, cranial neuropathy, myopathy and neuromuscular junction.
 
Sjögren’s syndrome: Patients with undiagnosed Sjögren’s syndrome may present with transverse myelitis with or without positive neuromyelitis optica antibodies, peripheral neuropathies, length-dependent sensorimotor polyneuropathy, mononeuritis multiplex, small fiber neuropathy and a pure sensory neuropathy.
 
Scleroderma: Anywhere from 19% to 40% of patients with scleroderma may present with neurological manifestations, including brachial plexopathy, distal axonal sensorimotor peripheral neuropathy, entrapment neuropathies (particularly median) and mononeuritis multiplex.

The authors also discuss neurological complications of immunosuppressive therapies currently prescribed to treat some rheumatic conditions. These include NSAIDs, corticosteroids, chemotherapeutic agents and biologics. According to the authors, stroke has been reported in patients with vascular risk factors who received first-time IV immunoglobulin. Additionally, corticosteroids, antimalarials and the antibacterial dapsone have been associated with psychosis.

“Diagnosis of neurological complications in patients with established rheumatologic diagnoses is usually not difficult; however, diagnosis of a rheumatic disorder in a patient with a neurological manifestation as the presenting feature may be challenging,” the authors wrote. “Additionally, distinguishing neurotoxicity of rheumatologic treatments from manifestations of the rheumatic disease being treated or another cause may be problematic. Efficient diagnosis and treatment should be a multidisciplinary collaborative effort that includes expertise in rheumatology and rehabilitation among other fields.”

http://www.healio.com/rheumatology/systemic-lupus-erythematosus/news/online/%7Bdee186e2-5815-4dc4-88e8-006021607d4f%7D/neurological-symptoms-may-complicate-rheumatic-disorder-diagnosis