Samy Eman, Zahran Enas S, Sabry Mona, Elshony Hosna
Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Shebin El-kom, Egypt.
Department of Internal Medicine, Rheumatology & Immunology, Faculty of Medicine, Menoufia University, Shebin El-kom, Egypt.
BMC Rheumatol. 2024 Oct 31;8(1):57. doi: 10.1186/s41927-024-00424-4.
Systemic Lupus Erythematosus (SLE) is a multifaceted autoimmune disorder characterized by diverse clinical manifestations, including a significant prevalence of headaches. This cross-sectional study aimed to thoroughly explore the relationship between SLE and headaches by analysing their prevalence, types, and associated clinical, immunological, and radiological factors.
A comparative analysis was conducted on 179 SLE patients, who were categorized into two groups: those with headaches and those without. Data collection encompassed demographic details, disease activity levels, neurological assessments, immunological profiles, and brain imaging results. Headaches were diagnosed and classified following the International Classification of Headache Disorders (ICHD-3). Disease activity was measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Statistical analyses were performed to identify significant associations and correlations.
Headaches were observed in 55% of the SLE patients, predominantly presenting as tension-type headaches (65%) and migraines (27%). Notably, no patients met the criteria for a lupus-specific headache. The Headache Group exhibited significantly higher disease activity (SLEDAI scores). Tension-type and migraine headaches were particularly associated with increased muco-cutaneous manifestations. The presence of antiphospholipid (aPL) antibodies was significantly linked to migraines and cluster headaches. While neurological disorders such as ischemic stroke and venous sinus thrombosis were more prevalent in the Headache Group, these findings were not statistically significant. Brain MRI abnormalities were detected in 9.4% of patients with headaches, including venous sinus thrombosis (2.3%), ischemic stroke (5.8%), and white matter hyperintensities (1.1%).
This study underscore es the complex relationship between SLE and headaches, suggesting that headaches may serve as an indicator of heightened SLE disease activity. Immunological factors, particularly aPL antibodies, show a strong association with specific headache types. MRI abnormalities further emphasize the intricate neurobiological aspects in SLE patients experiencing headaches. Continued research is essential to better understand biomarkers, genetic factors, and effective treatment strategies for managing headaches in SLE patients.
系统性红斑狼疮（SLE）是一种多方面的自身免疫性疾病，其临床表现多样，包括头痛的显著患病率。这项横断面研究旨在通过分析SLE与头痛的患病率、类型以及相关的临床、免疫和放射学因素，全面探讨它们之间的关系。
对179例SLE患者进行了比较分析，将其分为两组：有头痛的患者和无头痛的患者。数据收集包括人口统计学细节、疾病活动水平、神经学评估、免疫学特征和脑成像结果。头痛按照《国际头痛疾病分类》（ICHD-3）进行诊断和分类。使用系统性红斑狼疮疾病活动指数（SLEDAI）测量疾病活动度。进行统计分析以确定显著的关联和相关性。
55%的SLE患者出现头痛，主要表现为紧张型头痛（65%）和偏头痛（27%）。值得注意的是，没有患者符合狼疮特异性头痛的标准。头痛组的疾病活动度（SLEDAI评分）显著更高。紧张型头痛和偏头痛尤其与黏膜皮肤表现增加有关。抗磷脂（aPL）抗体的存在与偏头痛和丛集性头痛显著相关。虽然缺血性中风和静脉窦血栓形成等神经系统疾病在头痛组中更为普遍，但这些发现无统计学意义。9.4%的头痛患者检测到脑MRI异常，包括静脉窦血栓形成（2.3%）、缺血性中风（5.8%）和白质高信号（1.1%）。
本研究强调了SLE与头痛之间的复杂关系，表明头痛可能是SLE疾病活动度增加的一个指标。免疫因素，特别是aPL抗体，与特定的头痛类型有很强的关联。MRI异常进一步强调了SLE头痛患者复杂的神经生物学方面。持续的研究对于更好地理解生物标志物、遗传因素以及管理SLE患者头痛的有效治疗策略至关重要。
