Autoantibodies and rheumatic disorders in a neurology inpatient population: a prospective study.
OBJECTIVE
To determine the prevalence and spectrum of underlying rheumatic diseases, especially Sjögren's syndrome (SS) and the antiphospholipid syndrome, and the prevalence of the lupus anticoagulant, antinuclear antibody (ANA), and rheumatoid factor (RF) within a neurologic patient population.


METHODS
The study design entailed a prospective, consecutive sample of patients admitted to a university-affiliated neurology service for 72 hours or more. Study patients were obtained from a sequential evaluation of 100 inpatients with a wide spectrum of neurologic diseases. Another 31 eligible patients were not included due to refusal (n = 4), inability to give consent (n = 12), or an incomplete database (n = 15). All patients underwent a physical examination and responded to a rheumatic disease questionnaire (administered by one rheumatologist) assessing signs and symptoms relevant to rheumatic disease. All had lupus anticoagulant, ANA, and RF determinations. An independent patient evaluation was done by the attending neurologist.


RESULTS
Eleven patients had a rheumatic or autoimmune disorder directly related to their neurologic admission: three patients with SS (one each with embolic stroke, dementia, and hemiparetic somatization); three patients with lupus anticoagulant syndrome (all with stroke, recurrent in two); one patient with systemic lupus erythematosus accompanied by migraine headache and the lupus anticoagulant; and one patient each with isolated central nervous system (CNS) angiitis, neuro-Behçet's disease, CNS Whipple's disease, and HLA-B27-associated spondyloarthropathy. Nineteen patients had one or more autoantibodies: ANA greater than or equal to 1:80 (n = 10); RF greater than or equal to 1:80 (n = 6); and positive lupus anticoagulant (n = 7). The seroreactivity of 10 of these patients remained unexplained.


CONCLUSIONS
This neurologic population demonstrated significant seroreactivity and rheumatic disease associations, with SS and lupus anticoagulant-related neurologic disease the most common. Since SS and the antiphospholipid syndrome can be overlooked, it is recommended that a formal evaluation for SS and a direct lupus anticoagulant assay should be considered in the examination of patients with neuropsychiatric symptoms.
Olsen
M L
ML
Department of Internal Medicine, University of Texas Health Science Center, Houston 77225.
O'Connor
S
S
Arnett
F C
FC
Rosenbaum
D
D
Grotta
J C
JC
Warner
N B
NB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000032:analysis* / Q000276:immunology; D001779:Blood Coagulation Factors / Q000032:analysis / Q000276:immunology*; D005260:Female; D006801:Humans; D016682:Lupus Coagulation Inhibitor; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D012217:Rheumatoid Factor / Q000032:analysis*; D012859:Sjogren's Syndrome / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D011795:Surveys and Questionnaires
D000974:Antibodies, Antinuclear; D001779:Blood Coagulation Factors; D016682:Lupus Coagulation Inhibitor; D012217:Rheumatoid Factor