‘A large overlap’: Autoimmune encephalitis can look like, coexist with rheumatic disease
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ORLANDO, Fla. — Although rheumatic diseases must be considered in a differential diagnosis of autoimmune encephalitis, some patients can have both, according to a presenter at the 2024 Rheumatology Nurses Society annual conference.
“A lot of these disorders present very similarly to rheumatic diseases, so it’s important to think about,” Joseph McDonald, MD, a pediatric rheumatologist at the University of Chicago Comer Children’s Hospital, told attendees. “Secondly, some of these conditions can actually coexist with our disorders, and it has a lot of implications around how we best treat these patients.”
According to McDonald, autoimmune encephalitis is marked by a rapid progression of short-term memory loss, altered mental status or psychiatric symptoms, and either new focal neurological findings, unexplained seizures, cerebrospinal fluid pleocytosis or MRI results suggestive of encephalitis.
“Encephalitis, in general, is just a severe inflammatory brain disorder with acute development of altered mental status,” he said. “There can be a very broad array of neuropsychiatric symptoms. However, what we’ve learned over time, as we’re discovering more of these antibodies, is that autoimmune encephalitis may actually be just as common as infectious causes of encephalitis.”
The differential diagnosis for possible autoimmune encephalitis is “broad,” according to McDonald. He added that the most important other causes to consider are bacterial, viral or parasitic infections. However, he also emphasized the importance of considering rheumatic diseases.
“ Think about lupus or Sjögren’s syndrome, both of which have a wide array of neurologic and even psychiatric manifestations,” he said. “You could also think about sarcoidosis or Behcet’s disease.”
Some inflammatory neurological disorders can also coexist with rheumatic diseases, presenting “a lot of implications” for treatment approaches and cross-specialty collaboration, McDonald said. As an example, he highlighted a recent systematic review that found neuromyelitis optica (NMO) spectrum disorder in about 1% of patients with lupus and 7% of patients with Sjögren’s — including 27% of those with neurological manifestations of Sjögren’s, he said.
“There is certainly a large overlap and it’s really important for treatment implications,” said McDonald, adding that usual medications “are not going to be effective for someone who has NMO in association with Sjögren’s disease.”
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McDonald J. Mind Matters: Deciphering Autoimmune Encephalitis in Adults and Children. Presented at: Rheumatology Nurses Society annual conference; July 17-20, 2024, in Orlando, Florida (hybrid meeting).
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