Systemic Lupus Erythematosus (SLE) is an autoimmune disease that has been affecting millions of people, both young and old worldwide. Numerous studies about this disease have been conducted by different academic, pharmaceutical, and medical organizations. Over the course of continuous and extensive lupus research, a link between systemic lupus erythematosus and peripheral neuropathy has been uncovered. Many researchers have formulated various hypotheses about the supposed connection between systemic lupus erythematosus and peripheral neuropathic disorders. Studies have been conducted in relation to lupus affecting the limbs – its epidemiology and diagnostic approach.
An Overview of Peripheral Neuropathy
Peripheral neuropathy is a neurological disorder affecting the peripheral nervous system. The nerves that are responsible for transporting information to the brain about external physical stimulation. When these nerves get damaged, the neurons will convey inaccurate signals or worse; the nerves will be completely devoid of their capacity to transmit signals and information to the brain.
The Peripheral Nervous System
When a person experiences peripheral neuropathy, either, if not all of the following subsystems, get affected:
- Autonomic Nervous System (ANS) – It is a critical part of the peripheral nervous system (PNS). It controls the physiological activities of the viscera or the internal organs and some of the natural, involuntary functions in the human body. This includes the body temperature, urination, digestion, and even sexual arousal. Damage in the ANS is referred to as dysautonomia or Autonomic Dysfunction.
- Somatic Nervous System (SoNS) – It refers to the part of the peripheral nervous system that controls the voluntary functions and movements of the body. Sensory nerves and motor nerves make up the SoNS. The sensory nerves transmit signals perceived by the sensory organs (e.g. skin, ears). These signals are then processed by the brain in order for the body to respond accordingly.
On the other hand, the motor nerves are responsible for sending responses from the brain to the skeletal and smooth muscles to execute the appropriate response of the body to a certain stimulus. Numbness, burning or tingling sensation, and muscle weakness are the most common complaints of people who were diagnosed with any somatic dysfunction.
Peripheral Neuropathy in Systemic Lupus Erythematosus
Due to the unknown etiology of lupus, many differential diagnoses have surfaced with regards to the neurological symptoms exhibited by a lupus patient. There are several neurological indicators that lead to the consideration of the possibility of lupus affecting the limbs. These indicators are referred to as Lupus Neuropathy. According to the 63rd Volume of the Journal of The Association of Physicians of India published in December 2015, patients diagnosed with SLE show the symptoms of the following peripheral neuropathic disorders:
- Guillain–Barré syndrome (GBS) – It is a rare syndrome in which a person’s immune system begins attacking the nerves as if they are foreign bodies. This occurrence results in the loss of sensation, breathing irregularities, and paralysis.
- Autonomic disorders – These are disorders resulting from the damage in the autonomic region of the PNS. The most common examples are urinary bladder malfunction, gastroparesis (the inability of the stomach to move food to the connecting digestive organs), and postural orthostatic tachycardia syndrome (the abnormal increase in heart rate when a person stands up from an at-rest position).
- Mononeuropathy – It is when a single peripheral nerve or nerve group becomes damaged. One of the most common mononeuropathy disorders is carpal tunnel syndrome. Carpal tunnel syndrome is the degenerative muscle damage in the hands due to the impairment of the arms’ median nerve.
- Polyneuropathy – This occurs when several nerves or nerve groups have been negatively affected. Polyneuropathy could be symmetrical or asymmetrical.
- Plexopathy – It is a disorder affecting the nerve networks around the lumbosacral and brachial plexus. It is manifested by the loss of sensory and motor skills or control.
Susceptibility of Older Patients to Peripheral Neuropathy
A team of biomedical researchers from Spain led by Pilar Toledano from the Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) in Catalonia, Spain conducted a study on 524 lupus patients. The statistical analysis of their research indicates the following results:
- 93 patients out of 524 or 17% of the sample size exhibited lupus neuropathy. About 90 out of the 93 are female patients.
- The range for the age of diagnosis among the 93 patients is 30.7-58.9 years old (44.8 ± 14.1 years).
- The results report that the average period in which patients with SLE have presented symptoms of peripheral neuropathy from the time of their SLE diagnosis is 88 months.
- The most prevalent type of Peripheral Neuropathy involved in SLE is polyneuropathy, and 34 out of 93 patients have polyneuropathy, which corresponds to 36.6%.
- About 23.7% (22 out of 93 patients) have shown signs of non-compression mononeuropathy.
- The third most prevalent types of neuropathy are cranial neuropathy (damage of the nerves to the brain) as observed in 7 patients, and myasthenia gravis (serious muscle weakness) represented by 7 patients. Each case corresponds to 7.5% occurrence.
- One patient showed symptoms of Guillain-Barré syndrome.
- The prevalence of peripheral neuropathy was observed in patients in the sample who were diagnosed with SLE at an older age.
The data from the study reports that the neuropathic disorders mentioned above are more prevalent in older SLE patients. In conclusion, the cases of lupus affecting the limbs are more likely to occur in older lupus patients.
The Conventional Treatment Approach for SLE Patients with Peripheral Neuropathy
Due to the advancement of medical and information technology, diverse treatment methods have been made available to lupus patients. The following treatment methods are most commonly applied to SLE patients with peripheral neuropathy:
- Intravenous Steroid Pulse Therapy – High doses of corticosteroid infusion are administered intravenously to enhance its potency and curb the intensity and onset of its side effects.
- Plasmapheresis – Plasma with antibodies that attack the body’s immune system are replaced with pristine plasma or any approved substitute.
- Intravenous (IV) Immunoglobulin – High doses of immunoglobulin is given to lupus patients to reinforce their affected immune system. IV immunoglobulin has promising effects on patients who hadn’t responded to the initial treatment.
- Ultrafiltration of Cerebrospinal Fluid – In the case of neurological disorders, alterations in the components and quantity of the cerebrospinal fluid. Ultrafiltration of Cerebrospinal Fluid is done to reestablish the equilibrium of the cerebrospinal fluid circulation.
A Fight Against Lupus
The fight against lupus and any other autoimmune diseases does not end in pain relief; it ends in the discovery of its cause and its cure. As implausible as it sounds, significant developments have been made when it comes to the treatment and ministration for lupus patients. Being in constant pain or physical weakness might have hindered many people with lupus from seeking the appropriate treatment and acknowledging advanced, unconventional, treatment options.
Millions of people diagnosed with lupus share stories of the improvements they have made as they fight against lupus. They talk about how they positively go on with their everyday tasks despite having lupus. The maintenance medications for lupus available in the market surely deliver their claims and contribute to the gradual and continuous development in the health conditions of lupus patients. With proper information, lifestyle changes, correct medication, and timely treatment, lupus can be highly manageable.
- Due to the unknown etiology of lupus, many differential diagnoses have surfaced with regards to the neurological symptoms exhibited by a lupus patient.
- Numbness, burning or tingling sensation, and muscle weakness are the most common complaints of people who were diagnosed with any somatic dysfunction.
- The cases of lupus affecting the limbs are more likely to occur in older lupus patients.