Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

Tayer-Shifman, Oshrat E; Bingham, Kathleen; Touma, Zahi

doi:10.1007/s40266-021-00911-0

Cited by 9 publications

(2 citation statements)

References 130 publications

(193 reference statements)

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“…Central nervous system, renal, gastrointestinal, and hematological manifestations are rare 3 and also less frequent than in idiopathic SLE 2 , except for neurological involvement for quinidine (up to 30%) 27 and lupus nephritis-like syndromes induced by hydralazine [28][29][30] , sulfasalazine, penicillamine, anti-TNFα, propylthiouracil, apixaban 31,32 , and also to phytotherapeutic agents 33 and anti-neutrophil cytoplasmic antibodies (ANCAs) vasculitis associated with hydralazine 30 .…”

Section: Clinical Manifestations Of Drug-induced Lementioning

confidence: 99%

Drug-induced lupus erythematosus

Gouveia,

Gonçalo

2023

PJDV

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Drug-induced lupus erythematosus is an autoimmune disease with unexpected onset after treatment with certain drugs. Clinically, this disease is very similar to idiopathic lupus erythematosus, although its manifestations are typically milder. In addition, the laboratory and histological changes of the induced forms are also not significantly different from the idiopathic condition, sometimes making the diagnosis of the drug-induced form a challenge for clinicians. This entity has been gaining relevance in the clinical setting and the number of drugs associated with it has been increasing, mainly due to the emergence of new biological therapies with a strong causal link with drug-induced lupus, such as tumor necrosis factor-alpha inhibitors. However, there are still no universally accepted diagnostic criteria to identify this disease, and information about its pathophysiology is still somewhat scarce, making it difficult to predict the most likely culprit drugs before there are enough reports to establish a strong link. In addition, although some risk factors have shown susceptibility for certain individuals, they are not yet fully understood. Given the possibility of disease reversal by the withdrawal of the offending drug, it is extremely important to be aware of the possible implication of a drug in the pathogenesis of this disease, and for clinicians who approach patients with lupus manifestations, particularly cutaneous manifestations, it is mandatory to look for the onset of new drugs used by the patient. This review will systematize the current knowledge about this drug-induced lupus, in terms of pathophysiology, clinical, histopathological, and laboratory manifestations, diagnosis, and treatment, as well as the most commonly implicated drugs.

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Section: Clinical Manifestations Of Drug-induced Lementioning

confidence: 99%

Drug-induced lupus erythematosus

Gouveia,

Gonçalo

2023

PJDV

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“…Systemic lupus erythematosus (SLE) is a multisystem chronic autoimmune disease (1) in which the nervous system is commonly affected (2). There are 19 neuropsychiatric SLE syndromes defined by the American College of Rheumatology (ACR) (3,4).…”

Section: Introductionmentioning

confidence: 99%

Assessing the Utility of the Montreal Cognitive Assessment in Screening for Cognitive Impairment in Patients With Systemic Lupus Erythematosus

Tayer-Shifman

Yuen

Green

et al. 2022

Arthritis Care & Research

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Screening for cognitive impairment (CI) in systemic lupus erythematosus (SLE) relies on the American College of Rheumatology (ACR) neuropsychological battery (NB). By studying the concurrent criterion validity, our goal was to assess the Montreal Cognitive Assessment (MoCA) as a screening tool for CI compared to the ACR-NB and to evaluate the added value of the MoCA to the Automated Neuropsychological Assessment Metrics (ANAM).Methods. A total of 285 adult SLE patients were administered the ACR-NB, MoCA, and ANAM. For the ACR-NB, patients were classified as having CI if there was a Z score of ≤-1.5 in ≥2 domains. The area under the curve (AUC) and sensitivities/specificities were determined. A discriminant function analysis was applied to assess the ability of the MoCA to differentiate between CI, undetermined CI, and non-CI patients.Results. CI was not accurately identified by the MoCA compared to the ACR-NB (AUC of 0.66). Sensitivity and specificity were poor at 50% and 69%, respectively, for the cutoff of 26, and 80% and 45%, respectively, for the cutoff of 28. The MoCA had a low ability to identify CI status. The addition of the MoCA to the ANAM led to improvement on the AUC by only 2.5%.Conclusion. The MoCA does not have adequate concurrent criterion validity to accurately identify CI in patients with SLE. The low specificity of the MoCA may lead to overdiagnosis and concern among patients. Adding the MoCA to the ANAM does not substantially improve the accuracy of the ANAM. These results do not support using the MoCA as a screening tool for CI in patients with SLE.

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