Spike in nightmares could be an early warning sign of lupus

An increase in the frequency of hallucinations and nightmares could be an early warning sign of autoimmune diseases like lupus, according to a study.

The researchers asked doctors to ask about nightmares, hoping it could help detect when symptoms are likely to appear earlier in patients. The study by the University of Cambridge and King’s College London included a survey of 676 people with lupus, a disease that causes the immune system to attack tissues and organs, and 400 doctors.

It also included detailed interviews with 69 people living with various chronic inflammatory autoimmune diseases, including lupus, and 50 doctors. The researchers asked patients about the time of onset of 29 neurological and mental health symptoms, including depression, hallucinations and loss of balance.

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In interviews, patients were asked to list the order in which symptoms usually occur. Just under one in four people reported hallucinations, although most said this did not occur until around the onset of the disease or later.

However, the interviews found that three out of five patients with lupus and one out of three with other rheumatology-related conditions had an increase in vivid and distressing nightmares before hallucinating.

Lead author Dr Melanie Sloan, from the Department of Public Health and Primary Care at the University of Cambridge, said: “It is important that doctors talk to their patients about these types of symptoms and spend time noting individual symptom progression each patient.

“Patients often know which symptoms are a bad sign that their illness is about to flare up, but both patients and doctors can be reluctant to discuss mental health and neurological symptoms, especially if they don’t realize that they can be part of autoimmune diseases. .”

According to Lupus UK, around 50,000 people in the UK are thought to have the condition. One patient described his nightmares as “horrible, like murder, like skin coming off people.”

They added that they believed this happened when they were “overwhelmed” and “the more stressed my body is, the more vivid and worse the dream would be.”

Professor David D’Cruz, from King’s College London, added: ‘For many years I have discussed nightmares with my lupus patients and thought there was a link with their disease activity.

“This research provides evidence for this, and we strongly encourage more physicians to ask about nightmares and other neuropsychiatric symptoms thought to be uncommon but actually very common in systemic autoimmunity to help us detect disease flares earlier.”

The study, published in eClinicalMedicine, also found that using the word “daymare” instead of hallucination was more effective for patients.

One patient in England told the researchers that the term “just made sense”. They added: “It’s not necessarily scary, it’s like having a dream and yet you’re awake in the garden.

“I’m seeing different things, like I’m coming out of it and it’s like you wake up and you don’t remember the dream and you’re there but you’re not there, it’s like I feel really disoriented, the closest thing I have All I can think of is that I feel like I’m Alice in Wonderland.”

Some interviewees with lupus were also misdiagnosed with mental health problems. One nurse told the researchers that she had seen patients “admitted for an episode of psychosis”.

They added that lupus is not usually the first thing to be screened for, leading to a “difficult few months” for patients.

Professor Guy Leschziner, study author and neurologist at Guys and St Thomas’ Hospital, said: “We have long known that changes in dreaming can signify changes in physical, neurological and mental health and can sometimes be early indicators of the disease.

“However, this is the first evidence that nightmares can also help us monitor such a serious autoimmune condition as lupus, and is an important reminder to both patients and doctors that sleep symptoms they can tell us about the imminent relapse”.

The study was funded by The Lupus Trust and is part of the Inspire project.

Angie Davidson, from the Lupus Trust, said: “We were very pleased to fund this important research, for years we suspected that nightmares and hallucinations were linked to lupus, many patients talk about these types of symptoms without knowing . it was part of their illness.

“This is a fantastic breakthrough in recognizing another area of ​​lupus that has gone, until now, unrecognized.”

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