r e v b r a s r e u m a t o l . 2016;56(3):189–190
w w w . r e u m a t o l o g i a . c o m . b r
REVISTA
BRASILEIRA
DE
REUMATOLOGIA
Editorial
Neuropsychiatric
manifestations
in
autoimmune
diseases
Manifestac¸ões
neuropsiquiátricas
em
doenc¸as
autoimunes
Neuropsychiatricmanifestationsinautoimmunediseasesare oftenobserved;theyareassociatedwithincreased morbid-ityandmortalityandwithapoorerqualityoflife.Although theirclassificationiscarriedoutonamoresystematicbasis in systemic lupuserythematosus (SLE) when compared to otherdiseases–inpartbecauseofitsprevalenceand diagnos-ticdifficulties–theirimportancecannotbeignoredinother rheumaticdiseases.
When patientswith autoimmune diseases present with neuropsychiatricmanifestations, weemphasize the impor-tanceofthe exclusionofcomorbidities,infectionsandside effectsrelatedtomedications. InSLE,only40% ofprimary manifestationsarerelatedtodiseaseactivity.1
ThestudybyvanWeeldenetal.2raisesanimportantpoint: theuseofalcoholand illicitdrugsinjuvenileSLE.Theuse ofalcoholand illicitdrugsis associatedwith neuropsychi-atricmanifestations,butaccordingtopopulationstudies,it canalsopromotethedevelopmentofpsychiatricdisordersin theabsence ofautoimmunediseases.3,4 Intheir study,van Weelden et al.2 observed a high frequency of alcohol use amongadolescentswith SLE(38%),but similar tomatched controls;butwithalowriskforillegalsubstancesand depend-enceinJSLEpatients.
InthestudybyAikawaetal.,5theauthorsobservedalow frequencyofhepatitisCinpatientswithJSLEversuscontrols (2.5%vs.0%,p=1.0).HepatitisCmustberoutinelyscreened inpatientswithautoimmunemanifestations;thisdiseaseis associatedwithneuropsychiatricmanifestations.6
Withregard toprimaryneuropsychiatricmanifestations, Costallatetal.,7intheiranalysisofalargecohortofpatients withSLE, observeda prevalenceof14 (1.2%) patients with myelopathy.Myelopathyoccurredindependentlyofthe asso-ciation withdisease activity,and no patient was benefited withacompleterecovery.Deathsoccurredin3(21%)patients duringanepisodeofmyelopathy,buttheseweredueto com-plicationsrelatedtotreatment.
InfectiouscomplicationsareoftenobservedinSLEpatients andareassociatedwithhighmortalityrates,particularlyin theearlyyearsofthedisease.Diseaseactivityand immuno-suppressionareimportantriskfactors.ThestudybySimioni etal.8showedthatlowVitaminDlevelsareassociatedwith leukopenia. Longitudinal studies with appropriate replace-ment of vitaminD are needed in order toassess whether adequate levelsofvitaminDmayhelpintheimprovement ofleukopeniaandinreducinginfectioninpatientswithSLE, thusimprovingmortality.
Conflicts
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interest
Theauthordeclaresnoconflictsofinterest.
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1.PostalM,CostallatLT,AppenzellerS.Neuropsychiatric manifestationsinsystemiclupuserythematosus:
epidemiology,pathophysiologyandmanagement.CNSDrugs. 2011;25(9):721–36.
2.vanWeeldenM,QueirozLB,Lourenc¸oDMR,KozuK,Lourenc¸o B,SilvaCA.Usodeálcool,tabacoedrogasilícitasporpacientes comlúpuseritematososistêmicodeinícionainfância.Rev BrasReumatol.2016;56:228–34.
3.AuerR,VittinghoffE,YaffeK,KünziA,KerteszSG,LevineDA, etal.Associationbetweenlifetimemarijuanauseand cognitivefunctioninmiddleage:theCoronaryArteryRisk DevelopmentinYoungAdults(CARDIA)study.JAMAIntern Med.2016;176(3):352–61.
4.HelleS,GjestadR,JohnsenE,KrokenRA,JørgensenHA,Løberg EM.Cognitivechangesinpatientswithacutephasepsychosis –effectsofillicitdruguse.PsychiatryRes.2014;220(3):818–24.
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rev bras reumatol.2016;56(3):189–1906.AdinolfiLE,NevolaR,LusG,RestivoL,GuerreraB,RomanoC, etal.ChronichepatitisCvirusinfectionandneurologicaland psychiatricdisorders:anoverview.WorldJGastroenterol. 2015;21(8):2269–80.
7.CostallatBL,FerreiraDM,CostallatLTL,AppenzellerS. MielopatianoLúpuseritematososistêmico:achadosclínicos, laboratoriais,radiológicoseevolutivosemumacoortede1193 pacientes.RevBrasReumatol.2016;56:240–51.
8.SimioniJA,HeimovskiF,SkareTL.Acercadolúpus,vitaminaD eleucopenia.RevBrasReumatol.2016;56:206–11.
SimoneAppenzeller FaculdadedeCiênciasMédicas,UniversidadeEstadual
deCampinas(UNICAMP),Campinas,SP,Brazil E-mail:appenzellersimone@yahoo.com
2255-5021/©2016PublishedbyElsevierEditoraLtda.Thisis anopenaccessarticleundertheCCBY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).
