Headache and systemic lupus erythematosus: A narrative review

OBJECTIVE

To review the epidemiology, the differential diagnosis, and the clinical and laboratory factors associated with the care management of headaches in patients with systemic lupus erythematosus (SLE).

BACKGROUND

SLE is a chronic autoimmune disease and in 12%-95% of patients, the nervous system is involved. Headache is a frequently reported, although nonspecific, symptom that may potentially represent serious underlying diagnoses. Primary headaches may also occur in these patients, thereby causing a negative and significant impact on their quality of life.

METHODS

This is a narrative review. A literature review was conducted on the PubMed platform using the following terms: (1) headache and (2) lupus. All articles considered relevant were included. No limitations were imposed for the publication date.

RESULTS

Headache is a frequent symptom in patients with SLE. Although its prevalence is similar to the general population, headaches nonetheless tend to have a greater negative impact on these patients. Patients with SLE are more likely to experience headache due to vascular diseases such as cerebral venous sinus thrombosis, stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and vasculitis. Aseptic meningitis, neuroinfections, intracranial neoplasms, and intracranial hypertension or hypotension may also be a cause of headache in these patients. Although used in disease activity scores, the concept of lupus headache is controversial.

CONCLUSIONS

Headache is a frequent symptom in patients with SLE. An appropriate approach enables the potentially serious conditions, which are the causes of secondary headaches, to be recognized and treated, together with an appropriate diagnosis and treatment of primary headaches.

Headache in patients with systemic lupus erythematosus: a pilot study

Introduction Headache is a symptom frequently reported by patients with Systemic Lupus Erythematosus (SLE), but it remains controversial as to whether the prevalence is higher than in the those without the disease and if there is an association with disease activity. Objectives 1) to compare the prevalence, monthly frequency and impact of headaches between patients with SLE and a control group without the disease and 2) to compare the prevalence, monthly frequency and impact of headaches between patients with active SLE and those without disease activity Methods This is a case-control study. The case group consisted of patients diagnosed with SLE in regular follow-up at the Rheumatology outpatient clinic of the Hospital das Clínicas, UFPE, excluding those with a previous diagnosis of secondary headache or overlapping autoimmune diseases. A control group, matched for sex and age, consisted of hospital staff and friends and relatives of patients who had no previous diagnosis of secondary headache or autoimmune disease. Data on SLE and headache were collected through interviews and questionnaires administered by a neurologist. Headache impact was assessed using the Headache Impact Test (HIT-6) scale, anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) and disease activity was evaluated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K modified scale, considering clinical and laboratory data from the last 30 days. All participants who reported at least one headache attack in the last year were considered as having headache and specific diagnoses were made based on the 3rd edition of the International Classification of Headache Disorders. SLE patients with SLEDAI-2K ≥ 6 were considered as having disease activity. Statistical analyzes were performed in SPSS 28.0 with significance defined as p < 0.05.... (To see the complet abstract, please, check out the PDF.)

Malignant otitis externa in a 21-year-old male patient with Prader-Willi syndrome

Malignant otitis externa is an invasive infection of the external auditory canal and temporal bone with potentially life-threatening complications. Elderly patients with type 2 diabetes mellitus are the population most commonly affected by malignant otitis externa, but any type of immunosuppression predisposes to the disease. Prader–Willi syndrome is a genetic cause of obesity, often associated with insulin resistance and type 2 diabetes mellitus. This report describes a case of a 21-year-old male patient with Prader–Willi syndrome who had malignant otitis externa that progressed to sepsis during hospitalization. To the best of the authors’ knowledge, this is the first description of malignant otitis externa in a young patient with Prader–Willi syndrome.

Antinociceptive, anti-inflammatory and antioxidant activities of aqueous extract from Remirea maritima (Cyperaceae)

ETHNOPHARMACOLOGICAL RELEVANCE

Remirea maritima Aubl., popularly known as "capim-da-praia", is popularly employed in the treatment of diarrhea, kidney disease, fever, and for analgesic and anti-inflammatory purposes through the preparation of teas. Few studies have focused on the chemical composition and its biological properties.

AIM OF THE STUDY

This work evaluated the antinocipetive, anti-inflammatory and antioxidant activities of the aqueous extract from Remirea maritima Aubl. as well as the isolation and identification of the chemical compounds.

MATERIALS AND METHODS

Compounds were isolated from aqueous extract of Remirea maritima through preparative HPLC and the structures were identified by means of NMR and MS analysis. The tests for antinociceptive, anti-inflammatory, and antioxidant activities, along with motor coordination test (Rota rod), were performed over the aqueous extract.

RESULTS

The phytochemical investigation of aqueous extract of Remirea maritima resulted in the isolation of three flavone glycosides. The structures of these compounds were determined by means of MS and 1D and 2D NMR data as vitexin-2″-O-β-D-glucopyranoside, isovitexin-2″-O-β-D-glucopyranoside, and luteolin-7-O-glucuronide. Acute pretreatment with aqueous extract (100, 200 or 400mg/kg, i.p.) caused a significant decrease (p<0.001) in the number of abdominal writhes. In the formalin test, higher doses significantly inhibited the late (inflammatory pain) phase of formalin-induced licking (p<0.05 or 0.001). In the hot plate test, there was no significant difference in nociceptive behavior, discarding the possible central effect of the aqueous extract. In the rota rod test, it was verified that the aqueous extract in all concentration evaluated does not alter the motor coordination of mice, such antinociceptive results were unlikely to be caused by motor abnormality. In the peritonitis test, induced by carrageenan, the treatment with aqueous extract produced a significant reduction in leukocyte migration in all concentration evaluated. Additionally, a significant reduction of lipoperoxidation (TBARS test) and in nitric oxide formation (.NO Scavenging assay) was observed in antioxidant activity assay.

CONCLUSION

The biological and phytochemical investigations of the aqueous extract of Remirea maritima resulted in the identification of three flavone glycosides that have been described here for the first time in Remirea and effective analgesic activity in various pain models, probably mediated via the inhibition of peripheral mediators which could be related to its strong antioxidant effect observed in vitro.