Movement Disorders and Chorea May Go Unrecognized in SLE, APS

Baizabal-Carvallo JF, Bonnet C, and Jankovic J. Movement disorders in systemic lupus erythematosus and the antiphospholipid syndrome. J Neural Transm. (2013) April 13. [Epub ahead of print]  PMID: 23580159

Some patients with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) may initially present with movement disorders, especially chorea. Physicians may not associate these symptoms with either disorder, thereby delaying diagnosis.

A recent review of the literature concludes that a “high index of suspicion is required” to enable early diagnosis and prompt treatment, in order to prevent further symptoms and  complications related to the autoimmune process. The reviewers found a prevalence of chorea at around 2% in SLE (1.3% in APS), often preceding more well-recognized signs. Patients with chorea may not meet the ACR SLE diagnostic criteria, thereby being mislabeled as having a ‘‘lupus-like’’ disease and going untreated.

Due to the preponderance of chorea among women and to reports of SLE chorea during pregnancy (chorea gravidarum), the researchers advise that SLE or APS should be suspected in any pregnant patient in whom chorea develops.

EULAR recently recommended dopamine antagonists for persistent chorea, combined with antiplatelet agents if antiphospholipid (aPL) antibodies are present. Other therapies have also been used with some success, but in the absence of randomized trials these benefits are difficult to assess.