Neuropsychiatric Symptoms Can Present at Any Stage of Lupus

54 percent of patients who experienced hallucinations reported first presentation more than one year after disease onset

By Elana Gotkine HealthDay Reporter

TUESDAY, May 21, 2024 (HealthDay News) — For patients with systemic lupus erythematosus (SLE), neuropsychiatric (NP) symptoms can first present at any stage in the disease course, according to a study published online May 20 in eClinicalMedicine.

Melanie Sloan, Dr.P.H., from the University of Cambridge in the United Kingdom, and colleagues obtained patient reports of the timing of their first episode of 29 NP symptoms relative to SLE non-NP symptom onset from surveys (676 SLE patients; 400 clinicians) and interviews (50 clinicians; 69 systemic autoimmune rheumatic disease [SARD] patients, including 27 with SLE).

The researchers found that in contrast to the prevailing view among many rheumatology participants and in the literature, most NP symptoms did not first present around the time of SLE onset. For example, 54 percent of those who experienced hallucinations reported first presentation more than one year after disease onset. A range of NP symptoms may be a prodrome to SLE/SARDs onset and later flares, including symptoms not represented in the existing criteria for classification. Of those patients who experienced hallucinations, there was evidence of a possible prodromal syndrome. Of these, 61 and 34 percent with SLE and other SARDs, respectively, reported increasingly disrupted dreaming sleep before hallucinations. A high degree of interpatient variation was seen in progression of symptoms in flares, while in individual patient’s recurrent flares, symptom progression was often similar.

“Our findings of an NP prodrome providing an ‘early warning system’ of disease onset and impending flares in some patients may enable earlier and more accurate identification and treatment of NPSLE/SLE (and potentially other SARD) flares,” the authors write.

One author disclosed ties to the publishing industry; a second author disclosed ties to the pharmaceutical industry.