Neuropsychiatric Problems in Lupus

Special Report


Roberta Horton, LCSW, ACSW 
Director, Department of Social Work Programs
Hospital for Special Surgery

Anxiety, headaches, difficulty concentrating, confusion, depression and other mood disorders, peripheral neuropathy (nerve disorders that can cause numbness or pain in hands and feet), problems with memory and thinking, psychosis, seizures, and other problems can all be symptoms of neuropsychiatric disease caused by lupus. How common are these problems? And how do they affect people with lupus? Those questions were the focus of a recent study reported at the American College of Rheumatology meeting.[1]

Patients often tell their doctors about such problems, but they have just beginning to be studied carefully by researchers in the last few years. Although they seem to be common problems in lupus, they have not been well-recognized and not well defined by doctors and patients.

A group of Canadian researchers reviewed 107 lupus patients whose average age was 44. They had had lupus, on average, for about 10 years. They found that 36% had neuropsychiatric symptoms of some type. And 58% of those symptoms could be attributed completely or in part to lupus.

Interestingly, those with neuropsychiatric manifestations had higher levels of lupus activity, and they reported more fatigue. They were also more likely to have received prednisone or immunosuppressive drugs. They reported a significantly lower quality of life than those who did not have neuropsychiatric problems. (A lower quality of life was not associated with kidney disease in lupus patients.)

This research points out that neuropsychiatric disease is common in people with lupus - so if you have problems, you are not alone. And the impact of these problems is very significant.

Neuropsychiatric disease causes many different symptoms - so if you experience any new symptoms, tell your doctor about them. Don't feel embarrassed by changes in your moods or thinking or feelings. A change in your mental status is something you should report to your doctor, just the way you would tell your doctor about joint pains or dry mouth or headache.

Your rheumatologist should respond with understanding that there may be a physical basis for what someone else might think are emotional symptoms. An evaluation and diagnosis can help to target an appropriate treatment plan.

[1] John G. Hanly, Grace McCurdy, Lisa Fougere, Kara Thompson, Jo-Anne Douglas. Neuropsychiatric Disease in Systemic Lupus Erythematosus (SLE): Attribution and Clinical Significance. Arthritis Rheum. 2003 Sep;48(9):S181.
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