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Drugs & Aging
Erschienen in: Drugs & Aging 2/2022

16.12.2021 | Review Article

Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

verfasst von: Oshrat E. Tayer-Shifman, Kathleen S. Bingham, Zahi Touma

Erschienen in: Drugs & Aging | Ausgabe 2/2022

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Abstract

Systemic lupus erythematosus (SLE) is a multisystem chronic autoimmune disease with variable clinical manifestations. Neuropsychiatric systemic lupus erythematosus (NPSLE) includes the neurologic syndromes of the central, peripheral and autonomic nervous system and the psychiatric syndromes observed in patients with SLE. Neuropsychiatric systemic lupus erythematosus events may present as an initial manifestation of SLE or may be diagnosed later in the course of the disease. Older adults with NPLSE include those who are ageing with known SLE and those with late-onset SLE. The diagnosis of NPSLE across the lifespan continues to be hampered by the lack of sensitive and specific laboratory and imaging biomarkers. In this review, we discuss the particular complexity of NPSLE diagnosis and management in older adults. We first discuss the epidemiology of late-onset NPSLE, then review principles of diagnosis of NPSLE, highlighting issues that are pertinent to older adults and that make diagnosis and attribution more challenging, such as atypical disease presentation, higher medical comorbidity, and differences in neuroimaging and autoantibody investigations. We also discuss clinical issues that are of particular relevance to older adults that have a high degree of overlap with SLE, including drug-induced lupus, cerebrovascular disease and neurocognitive disorders. Finally, we review the management of NPSLE, mainly moderate to high- dose glucocorticoids and immunosuppressants, again highlighting considerations for older adults, such as increased medication (especially glucocorticoids) adverse effects, ageing-related pharmacokinetic changes that can affect SLE medication management, medication dosing and attention to medical comorbidities affecting brain health.
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Metadaten
Titel
Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management
verfasst von
Oshrat E. Tayer-Shifman
Kathleen S. Bingham
Zahi Touma
Publikationsdatum
16.12.2021
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 2/2022
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-021-00911-0

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