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Lupus Erythematosus

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Copyright © 2012. Nova Science Publishers, Inc. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

In regard to therapy, it is first important to realize that neurologic involvement in lupus is common [62]. Second, in the vast majority of patients there is complete resolution of neurologic problems over time, provided they are addressed properly. If the neurologic symptoms present dramatically, ie, with fits or severe neuropsychiatric disease, the treatment (as with most active forms of lupus) should be with steroids and immunosuppressive drugs. The doses of steroids used are less than previously utilized (for example, 60mg daily in the majority of the worst cases); rarely is a higher dose required. An alternative way of giving steroids is by “pulse” injections on an intermittent basis [59-61]. The puse method is becoming more popular, as it is a simple and more rapidly effective way of administrating steroids, especially in emergencies. As previously noted, a distinct form of brain involvement in lupus is associated with the antiphospholipid or Hughes syndrome [62]. In this complication, the neurologic etiopathogenesis is secondary to microthrombi in neural blood vessels. In patients where the antiphospholipid syndrome is suspected, brain scans are usually performed. The brain scans may show localized areas where blood supply has been inadequate. The treatment in these patients requires thinning of the blood, either with aspirin or, in more severe cases with anticoagulants such as warfarin (Coumadin) [62]. For less dramatic brain involvement, the decision to treat is more problematic. Many patients are not treated, who should be treated. In some patients, depression is a major problem and requires conventional anti-depressive treatment. The more modern medications for depression are superior to older medications, causing far less side effects. The opinion of a psychiatrist may be sought to address whether medical psychiatric treatment is appropriate, especially given the dangers of drug interactions. In summary, the vast majority of patients who experience lupus brain involvement may be treated successfully and return to normal daily activities [59- 61]. Anxiety and depression are common symptoms felt by lupus patients. Finally, other neurologic sequelae may present in lupus patients. Central nervous system vasculitis represents inflammation of the blood vessels of the brain. It is characterized by high fevers, psychosis, seizures, and meningitis-like neck stiffness, leading to stupor and coma if not quickly and aggressively treated [63,64]. Cognitive dysfunction may occur in lupus, and may include memory loss, loss of concentration, confusion and difficulty expressing thoughts. Cognitive dysfunction may present as an intermittent or constant clinical problem; it is sometimes referred to as "lupus brain fog". Also, up to 30% of people with lupus have a simultaneous fibromyalgia, evidenced by tender points and increased pain in the soft tissues. Patients with a fibromyalgia may also experience cognitive dysfunction, difficulty sleeping, and lack of stamina. As previously noted, lupus headaches may present with a migraine character [59-61]; these headaches are more common in lupus patients with antiphospholipid syndrome or Raynaud's phenomenon. These severe headaches are often treated similar to other migraines; although corticosteroids are also usually helpful, distinguishing it from other types of migraines. Intracranial hypertension (pseudotumor cerebri) is a rare complication of lupus and can also be caused by the medications used to treat lupus. The most common symptoms are severe non-specific headaches, transient altered vision, and tinnitus [59-61]. Other symptoms may include a stiff neck, back pain, double vision, pain behind the eyes, and exercise intolerance. Diagnosis is achieved via 1) a complete eye examination, 2) tests to rule out other causes of increased intercranial pressure and 3) a high opening pressure on lumbar puncture (spinal tap). Peripheral neuropathy is a symptom most commonly associated with diabetes; however, peripheral neuropathy may also be encountered in lupus. Peripheral nerves, in contradistinction to cranial nerves, represent nerves located in the arms, legs and

Lupus Erythematosus 23 Copyright © 2012. Nova Science Publishers, Inc. All rights reserved. May not be