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Neuropsychiatric Manifestations of Rheumatic Diseases in the Elderly

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Geriatric Rheumatology

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Abstract

Neuropsychiatric (NP) syndromes in rheumatic disorders in the elderly represent a field of medicine situated at the crossroads of neurology, psychiatry, rheumatology, immunology, and geriatrics. NP symptoms highly prevalent in rheumatic conditions, are a major source of disability and diminished quality of life, and potentially represent the target of treatment interventions that stand to significantly decrease the suffering they generate. The NP manifestations in rheumatic diseases in the elderly may be focal or generalized or a secondary consequence of the primary disease. A focal cerebral event may result in (1) a stroke-like presentation with an acute neurologic deficit, (2) a headache due to hemorrhage (e.g., subarachnoid hemorrhage in vasculitis) or temporal arteritis, (3) focal seizures, (4) optic neuropathy or cranial neuropathies due to compression by granulomatous lesions. A generalized event may result in cognitive dysfunction, headaches, or seizures. The spinal cord may be involved with resulting paraparesis, bowel or bladder dysfunction, or sensory disturbances. A common peripheral nervous system involvement is peripheral neuropathy, with symptoms of numbness, sensory paresthesias, weakness, or gait imbalance; nevertheless neuropathy may be multifocal and asymmetric. The presence of comorbid conditions and treatment adverse events including infections associated with immunosuppressive treatment or biologic therapy may compound the sign and symptoms of the NP syndromes of the underlying disease.

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References

  1. Fulop Jr T, Larbi A, Dupuis G, Pawelec G. Aging, autoimmunity and arthritis: Perturbations of TCR signal transduction pathways with ageing—a biochemical paradigm for the aging immune system. Arthritis Res Ther. 2003;5:290–302.

    Article  PubMed  Google Scholar 

  2. Godbout JP, Johnson RW. Age and neuroinflammation: a lifetime of psychoneuroimmune consequences. Neurol Clin. 2006;24:521–38.

    Article  PubMed  Google Scholar 

  3. Stichel CC, Luebbert H. Inflammatory processes in the aging mouse brain: participation of dendritic cells and T-cells. Neurobiol Aging. 2007;28:1507–21.

    Article  CAS  PubMed  Google Scholar 

  4. Rovensky J, Tuchynova A. Systemic lupus erythematosus in the elderly. Autoimmun Rev. 2008;7:235–9.

    Article  CAS  PubMed  Google Scholar 

  5. Lazaro D. Elderly-onset systemic lupus erythematosus: prevalence, clinical course and treatment. Drugs Aging. 2007;24:701–15.

    Article  CAS  PubMed  Google Scholar 

  6. Bertoli AM, Alarcón GS, Calvo-Alen J, Fernandez M, Vila LM, Reveille JD. LUMINA Study Group. Systemic lupus erythematosus in a multiethnic US cohort. XXXIII. Clinical [corrected] features, course, and outcome in patients with late-onset disease. Arthritis Rheum. 2006;54:1580–7.

    Article  PubMed  Google Scholar 

  7. Ward MM, Polisson RP. A meta-analysis of the clinical manifestations of older-onset systemic lupus erythematosus. Arthritis Rheum. 1989;32:1226–32.

    Article  CAS  PubMed  Google Scholar 

  8. Costallat LT, Coimbra AM. Systemic lupus erythematosus: clinical and laboratory aspects related to age at disease onset. Clin ExpRheumatol. 1994;12:603–7.

    CAS  Google Scholar 

  9. Ho CT, Mok CC, Lau CS, Wong RW. Late onset systemic lupus erythematosus in southern Chinese. Ann Rheum Dis. 1998;57: 437–40.

    Article  CAS  PubMed  Google Scholar 

  10. Antolin J, Amerigo MJ, Cantabrana A, Roces A, Jimenez P. Systemic lupus erythematosus: clinical manifestations and immunological parameters in 194 patients: subgroup classification of SLE. Clin Rheumatol. 1995;14:678–85.

    Article  CAS  PubMed  Google Scholar 

  11. Ballok DA. Neuroimmunopathology in a murine model of neuropsychiatric lupus. Brain Res Rev. 2007;54:67–79.

    Article  CAS  PubMed  Google Scholar 

  12. Scolding NJ, Joseph FG. The neuropathology and pathogenesis of systemic lupus erythematosus. Neuropathol Appl Neurobiol. 2002;28:173–89.

    Article  CAS  PubMed  Google Scholar 

  13. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999; 42:599–608.

    Google Scholar 

  14. Ardilla A. Normal aging increases cognitive heterogeneity: analysis of dispersion in WAIS-III scores across age. Arch Clin Neuropsychol. 2007;22:1003–11.

    Article  Google Scholar 

  15. Quemeneur T, Lambert M, Hachulla E, Dubucquoi S, Caron C, Fauchais AL, et al. Significance of persistent antiphospholipid antibodies in the elderly. J Rheumatol. 2006;33:1559–62.

    PubMed  Google Scholar 

  16. Bonfa E, Golombek SJ, Kaufman LD, Skelly S, Weissbach H, Brot N, et al. Association between lupus psychosis and anti-ribosomal P protein antibodies. N Engl J Med. 1987;317:265–71.

    Article  CAS  PubMed  Google Scholar 

  17. Isshi K, Hirohata S. Association of anti-ribosomal P protein antibodies with neuropsychiatric systemic lupus erythematosus. Arthritis Rheum. 1996;39:1483–90.

    Article  CAS  PubMed  Google Scholar 

  18. Conti F, Alessandri C, Bompane D, Bombardieri M, Spinelli FR, Rusconi AC, et al. Autoantibody profile in systemic lupus erythematosus with psychiatric manifestations: a role for anti-endothelial-cell antibodies. Arthritis Res Ther. 2004;6:R366–72.

    Article  CAS  PubMed  Google Scholar 

  19. Gerli R, Caponi L, Tincani A, Scorza R, Sabbadini MG, Danieli MG, et al. Clinical and serological associations of ribosomal P autoantibodies in systemic lupus erythematosus: prospective evaluation in a large cohort of Italian patients. Rheumatology (Oxford). 2002;41:1357–66.

    Article  CAS  Google Scholar 

  20. Sullivan EV, Pfefferbaum A. Neuroradiological characterization of normal adult ageing. Br J Radiol. 2007;80:S99–108.

    Article  PubMed  Google Scholar 

  21. Merrill JT, Neuwelt CM, Wallace DJ, Shanahan JC, Latinis KM, Oates JC, et al. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: The randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 2010;62:222–33.

    Article  CAS  PubMed  Google Scholar 

  22. Levin SR, Brey RL, Tilley BC, Thompson JL, Sacco RL, Sciacca RL, et al. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA. 2004;291:576–84.

    Article  PubMed  Google Scholar 

  23. Hereng T, Lambert M, Hachulla E, Samor M, Dubucquoi S, Caron C, et al. Influence of aspirin on the clinical outcomes of 103 anti-phospholipid antibodies-positive patients. Lupus. 2008;17: 11–5.

    Article  CAS  PubMed  Google Scholar 

  24. Carsons S, Talal N. Sjögren’s syndrome in the 21st century. Intl J Adv Rheumatol. 2003;1:139–47.

    Google Scholar 

  25. Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjögren’s syndrome. Arch Intern Med. 2004;164: 1275–84.

    Article  PubMed  Google Scholar 

  26. Ng KP, Isenberg DA. Sjögren’s syndrome: diagnosis and therapeutic challenges in the elderly. Drugs Aging. 2008;25:19–33.

    Article  CAS  PubMed  Google Scholar 

  27. Tzioufas AG, Voulgarelis M. Update on Sjögren’s syndrome autoimmune epithelitis: from classification to increased neoplasia. Best Pract Res Clin Rheumatol. 2007;21:989–1010.

    Article  CAS  PubMed  Google Scholar 

  28. Attwood W, Poser CM. Neurologic complications of Sjögren’s syndrome. Neurology. 1961;11:1034–41.

    CAS  PubMed  Google Scholar 

  29. Goransson LG, Herigstad A, Tjensvoll AB, Harboe E, Mellgren SI, Omdal R. Peripheral neuropathy in primary Sjögren’s syndrome: a population-based study. Arch Neurol. 2006;63:1612–5.

    Article  PubMed  Google Scholar 

  30. Andonopoulos AP, Lagos G, Drosos AA, Moutsopoulos HM. The spectrum of neurological involvement in Sjögren’s syndrome. Br J Rheumatol. 1990;29:21–3.

    Article  CAS  PubMed  Google Scholar 

  31. Delalande S, de Seze J, Fauchais AL, Hachulla E, Stojkovic T, Ferriby D, et al. Neurologic manifestations in primary Sjögren’s syndrome: a study of 82 patients. Medicine (Baltimore). 2004;83: 280–91.

    Article  Google Scholar 

  32. Valtysdottir ST, Gudbjornsson B, Lindqvist U, Hallgren R, Hetta J. Anxiety and depression in patients with primary Sjögren’s syndrome. J Rheumatol. 2000;27:165–9.

    CAS  PubMed  Google Scholar 

  33. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. European Study Group on classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554.

    Article  CAS  PubMed  Google Scholar 

  34. Morgen K, McFarland HF, Pillemer SR. Central nervous system disease in primary Sjögren’s syndrome: the role of magnetic resonance imaging. Semin Arthritis Rheum. 2004;34:623–30. Review.

    Article  PubMed  Google Scholar 

  35. Shirota Y, Illei GG, Nikolov NP. Biologic treatments for systemic rheumatic diseases. Oral Dis. 2008;14:206–16.

    Article  CAS  PubMed  Google Scholar 

  36. Moore PM, Cupps TR. Neurological complications of vasculitis. Ann Neurol. 1983;14(2):155–67.

    Article  CAS  PubMed  Google Scholar 

  37. Nadeau SE. Neurologic manifestations of systemic vasculitis. Neurol Clin. 2002;20:123–50. Review.

    Article  PubMed  Google Scholar 

  38. Hunder GG. Giant cell arteritis and polymyalgia rheumatica. Med Clin North Am. 1997;811:195–219.

    Article  Google Scholar 

  39. Walker RA, Wadman MC. Headache in the elderly. Clin Geriatr Med. 2007;23:291–305.

    Article  PubMed  Google Scholar 

  40. Nesher G. Neurologic manifestations of giant cell arteritis. Clin Exp Rheumatol. 2000;18:S24–6.

    CAS  PubMed  Google Scholar 

  41. Pfadenhauer K, Roesler A, Golling A. The involvement of the peripheral nervous system in biopsy proven active giant cell arteritis. J Neurol. 2007;254:751–5.

    Article  CAS  PubMed  Google Scholar 

  42. Nesher G, Berkun Y, Mates M, Baras M, Rubinow A, Sonnenblick M. Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum. 2004;50:1332–7.

    Article  CAS  PubMed  Google Scholar 

  43. Jennette J, Falk R, Andrassy K, et al. Nomenaclature of systemic vasculitis. Proposed of an international consensus conference. Arthritis Rheum. 1994;37:187–92.

    Article  CAS  PubMed  Google Scholar 

  44. Tervaert JWC, Kallenberg C. Neurologic manifestations of systemic vasculitides. Rheum Dis Clin North Am. 1993;19: 913–40.

    CAS  PubMed  Google Scholar 

  45. Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsles W, et al. Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and Polyarteritis nodosa for epidemiological studies. Ann Rheum Dis. 2007;66:222–7.

    Article  PubMed  Google Scholar 

  46. Cattaneo L, Chierici E. pavone L, Grasselli C, Manganelli P, Buzio C, Pavesi G. Peripheral neuropathy in Wegener’s granulomatosis, Churg-Strauss syndrome and microscopic polyangiitis. J Neurol Neurosurg Psychiatry. 2007;78:1119–23.

    Article  PubMed  Google Scholar 

  47. de Groot K, Schmidt DK, Arlt AC, Gross WL, Reinhold-keller E. Standardized neurologic evaluations of 128 patients with Wegener granulomatosis. Arch Neurol. 2001;58:1215–21.

    Article  PubMed  Google Scholar 

  48. Lie JT. Primary (granulomatous) angiitis of the central nervous system: a clinicopathologic analysis of 15 new cases ands a review of literature. Hum Pathol. 1992;23:164–71.

    Article  CAS  PubMed  Google Scholar 

  49. Chang DJ, Paget SA. Neurologic complications of rheumatoid arthritis. Rheum Dis Clin North Am. 1993;19:955–73. Review.

    CAS  PubMed  Google Scholar 

  50. Kato T, Hoshi K, Sekijima Y, Mastuda M, Hashimoto T, Otani M, et al. Rheumatoid meningitis: an autopsy report and review of the literature. Clin Rheumatol. 2003;22:475–80.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Maryland School of Medicine, 10 South Pine St., Suite 834, Baltimore, MD, 21201, USA

    Jamal A. Mikdashi

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  1. Jamal A. Mikdashi
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Correspondence to Jamal A. Mikdashi .

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  1. Sanford Health Systems, 32nd Ave S 2400, Fargo, 58103, North Dakota, USA

    Yuri Nakasato

  2. , Department of Internal Medicine, University of Michigan, Zina Pitcher Place 109, Ann Arbor, 48109, Michigan, USA

    Raymond L. Yung

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Mikdashi, J.A. (2011). Neuropsychiatric Manifestations of Rheumatic Diseases in the Elderly. In: Nakasato, Y., Yung, R. (eds) Geriatric Rheumatology. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5792-4_4

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  • DOI: https://doi.org/10.1007/978-1-4419-5792-4_4

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