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Study on autoimmune mechanisms in the neurological process
  1. A Muñoz,
  2. R Martínez,
  3. M León,
  4. F Gallo,
  5. ML Velloso,
  6. S Rodríguez,
  7. L Mayordomo,
  8. E Rejón,
  9. JL Marenco
  1. Rheumatology Unit, Valme University Hospital, Seville, Spain

Abstract

Objectives Systemic autoimmune disease can have neurologic manifestations. The following study analyses the awareness among neurologists on this topic.

Materials and methods Descriptive study: The authors have reviewed the clinical history of patients between 15 and 45 years old, with neurologic events between codes 433 and 438 of the ICD-19 (mainly ischemic events, bleeding, motors disorders…). The authors have collected demographic data and analytical.

Results 143 patients, 95 male (66.43%) and 48 female (33.57%). The majority of admissions were patients between 40 and 45 years old (42.7%). Under 30 years old admitted 20.98% and only five patients (3.5%) under 20 years old.

In all patients were requested general analytic study. Hypercoagulability study in 72 patients (50.35%), antinuclear antibody (ANA) in 70 (48.95%), C3 and C4 in 26 (18.18%), anti-neutrophil cytoplasmic antibodies (ANCAs) in 20 (13.99%), lupus anticoagulant in 7 (4.9%) and cryoglobulins in 5 (3.50%).

When performing an analysis by age, the authors found the hypercoagulability study was requested in 60% of patients under 30 years old, while only in 37.76% of patients between 31 and 45 years old. The seven patients who requested lupus anticoagulant were over 35 years old. ANA were requested in 56.67% of patients under 30 years old. In none of the five patients under 20 years old requested this study. Between 31 and 45 years old, the neurologists investigated the presence of ANAs in 37.06%. Only four of the patients under 30 years old (13.33%) requested the study of ANCAs. This study was requested in 14.16% of patients between 30 and 45 years old.

As for the analytical data, leucopoenia was detected in nine patients (6.29%), neutropoenia in five (3.50%), thrombocytopenia in five (3.50%) elongated APTT in six (4.2%) alterations in urinary sediment in eight patients (5.59%). The authors identified three patients (2.1%) with systemic lupus erythematosus according to American College of Rheumatology criteria (two patients were diagnosed prior to admissions, an one was diagnosed during hospitalisation).

Conclusions The sensitivity of neurologists regarding the involvement of autoimmune phenomena in neurological processes is lower than expected. Hypercoagulability study and ANA are the most requested, and the percentage of their request is higher in individuals under than 30 years. It seems that there is greater awareness about these diseases in younger patients.

It would be of interest to establish measures in collaboration between neurologists-rheumatologists to improve the diagnostic approach to these patients.

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