Headaches in lupus patients not linked to disease activity study says

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Headaches in lupus patients not linked to disease activity study says Headache is common among patients with system lupus erythematosus according to new research published in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR). The study found that 18% of lupus patients experienced headache at the onset of their disease with that number increasing to 58% after 10 years. While headaches were linked to a lower health-related quality of life, these episodes resolved over time independent of treatment specific to lupus and were not associated with disease activity or specific lupus autoantibodies.

Lupus is a systemic autoimmune disease where the immune system is overactive, attacking healthy joints and organs of the body including the nervous system. Studies suggest that up to 38% of neurological and psychiatric events in lupus patients are a result of the disease. However, the association between headache disorders and lupus is debatable, with prior research reporting prevalence rates that range from 24% to 72%.

Lead author, Dr. John Hanly from Dalhousie University and the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia Canada explains, "There is conflicting evidence that links headache, including migraine, and lupus disease activity. Much of the discrepancy in previous studies may be due the lack of uniform definition of headache, which is a common occurrence in the general population, especially among women."

The present study received core funding from the Canadian Institutes of Health Research (CIHR), and was performed by the Systemic Lupus International Collaborating Clinics (SLICC), a research network of 30 international medical centers. Dr. Hanly and colleagues recruited 1732 lupus patients between October 1999 and September 2011. Study subjects were assessed annually for headache and other neuropsychiatric events. The mean age of participants was roughly 35 years, with 89% of participants being female and 48% were Caucasian.

Findings indicate that at the commencement of the study nearly 18% of participants had headache—61% with migraine, 37% tension, 7% intractable non-specific, 3% cluster and 1% intracranial hypertension. After 10 years researchers found that the proportion of patients who ever reported a headache increased to 58% , with only 2% of subjects reporting a "lupus headache" that is described by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI) as a "severe, persistent headache: which may be migrainous, but unresponsive to narcotic analgesia."

Researchers found no association between headache and specific lupus autoantibodies or lupus medications such as steroids, antimalarials, and immunosuppressives. "While lupus patients with headaches reported lower quality of life, the majority of cases resolved on their own without lupus-specific therapies," concludes Dr. Hanly.

In a related editorial, Dr. Michael Lockshin, with Weill Cornell Medical College and Hospital for Special Surgery in New York, agrees, "Hanly et al. strongly suggest that lupus headache is not a sign of disease activity, but may be linked to other neurological manifestations. The current headache SLEDAI criterion no longer seems to be useful and should be discarded as a method for evaluating lupus flares."

### This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of this article may contact sciencenewsroom@wiley.com.

Full citations: "Headache in Systemic Lupus Erythematosus: Results from a Prospective, International, Inception Cohort Study." John G. Hanly, Murray B. Urowitz, Aidan G. O'Keeffe, Caroline Gordon, Sang-Cheol Bae, Jorge Sanchez-Guerrero, Juanita Romero-Diaz, Ann E. Clarke, Sasha Bernatsky, Daniel J Wallace, E.M. Ginzler, David A. Isenberg, Anisur Rahman, Joan T. Merrill, M. Petri, Paul R. Fortin, D. D. Gladman, Barri J. Fessler, Graciela S. Alarcon, Ian N. Bruce, M.A. Dooley, Kristjan Steinsson, Munther A. Khamashta, Rosalind Ramsey-Goldman, Susan Manzi, Gunnar K. Sturfelt, Ola Nived, Asad A. Zoma, R.F. van Vollenhoven, Manuel Ramos-Casals, Cynthia Aranow, Meggan Mackay, Guillermo Ruiz-Irastorza, Kenneth C. Kalunian, Sam Lim, Murat Inanc, Diane L. Kamen, Christine A. Peschken, Soren Jacobsen, Chris Theriault, Kara Thompson and Vernon Farewell. Arthritis & Rheumatism; Published Online: October 28, 2013 (DOI: 10.1002/art.38106).

URL Upon Publication: http://doi.wiley.com/10.1002/art.38106

Editorial: "Splitting Headache." Michael D. Lockshin. Arthritis & Rheumatism; Published Online: October 28, 2013 (DOI: 10.1002/art.38108).

URL Upon Publication: http://doi.wiley.com/10.1002/art.38108

About the Author: To arrange an interview with Dr. John Hanly, please contact Allison Gerrard with Dalhousie University Faculty of Medicine at Allison.gerrard@dal.ca or John Gillis with Capital Health JohnW.Gillis@cdha.nshealth.ca.

About the Journal Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and covers all aspects of inflammatory disease. The American College of Rheumatology is the professional organization whose members share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The journal is published by Wiley on behalf of the ACR. For more information, please visit http://wileyonlinelibrary.com/journal/art.

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