Clues for previously undiagnosed connective tissue disease in patients with trigeminal neuralgia.
BACKGROUND
Connective tissue diseases (CTD) may be associated with idiopathic trigeminal neuralgia (TN). The prevalence and diagnostic implications of this association are, however, not well established.


OBJECTIVE
The objective of this study was to evaluate, in TN patients, if rheumatologic clinical and laboratory findings could contribute to the early diagnosis of rheumatic diseases.


METHODS
Forty-six consecutive TN patients, 67% female, mean disease duration 8.78 +/- 7.25 years, and 47 controls were initially interviewed using a standard questionnaire based on common signs/symptoms of systemic lupus erythematosus, Sjögren syndrome, mixed CTD, and systemic sclerosis. Autoantibodies were detected by standard techniques. Those with rheumatologic complaints or positive autoantibodies were referred to the Rheumatology Outpatient Clinic for a more detailed evaluation. Secondary causes of TN were excluded.


RESULTS
The frequency of Raynaud phenomenon (P = 0.026) and ANA reactivity (P = 0.04) were significantly higher in TN patients compared with controls. Fourteen TN patients were ANA positive. Seven of them reported concomitant rheumatic complaints, and interestingly, diffuse CTD was diagnosed in 4 (57%) of these patients: 1 systemic lupus erythematosus; 2 Sjögren syndrome; and 1 undifferentiated disease with scleritis and positive parotid scintigraphy. In all cases, TN preceded by at least 10 months the rheumatologic signs/symptoms. Moreover, these 4 TN patients with CTD had a higher frequency of sicca symptoms (P = 0.001) and higher titers of ANA (>or=1:320) (P = 0.006) than the remaining 42 TN patients without CTD diagnoses. Sixteen patients had isolated laboratory or clinical abnormalities, and none of them had CTD diagnoses.


CONCLUSIONS
The concomitant presence of sicca symptoms and high titer ANA are clues for the early investigation of rheumatic diseases in TN patients.
Nascimento
Iana Souza
IS
Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil.
Bonfá
Eloísa
E
de Carvalho
Jozélio Freire
JF
Saad
Carla Gonçalves
CG
Vendramini
Margarete Borges Galhardo
MB
Teixeira
Manoel Jacobsen
MJ
Nóbrega
José Cláudio Marinho
JC
Viana
Vilma Santos Trindade
VS
D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003240:Connective Tissue Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011928:Raynaud Disease / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D012859:Sjogren's Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D014277:Trigeminal Neuralgia / Q000097:blood / Q000150:complications* / Q000276:immunology
D000974:Antibodies, Antinuclear; D015415:Biomarkers