Introduction:

A prompt diagnosis of neurological involvement in rheumatic diseases is essential to initiate timely treatment and prevent disease progression.

Purpose:

To describe the main characteristics of immunosuppressants used in rheumatic diseases with nervous system involvement.

Materials and Methods:

A scoping review was conducted through an extensive literature search in databases such as PUBMED, Cochrane, and BVS, as well as in gray literature.

Results:

The most commonly used immunosuppressants in rheumatic diseases with neurological involvement were identified. Cyclophosphamide, azathioprine, mycophenolate, and rituximab have specific indications. Monitoring their toxicity is crucial, prioritizing renal function for immunoglobulin and hematologic toxicity for other drugs.

Discussion:

Cyclophosphamide is an alkylating agent indicated in neurological conditions caused by pathologies such as systemic lupus erythematosus (SLE), Sjögren's syndrome, sarcoidosis, Behçet, among others, and is part of schemes such as NIH and CYCLOPS. Azathioprine, a purine analogue, is used in diseases such as neuropsychiatric lupus and neuro-Behçet, among others, sharing similar indications to mycophenolate. Rituximab acts against the B-cell CD20 antigen and is used in different doses for multiple neuro-rheumatological conditions. Monitoring of these drugs, especially for haematological toxicity, is essential, with the exception of immunoglobulin, in which case renal function and the risk of thrombotic events should be monitored.

Conclusions:

Knowledge of therapies used to treat neurological complications in rheumatic diseases, along with monitoring and preventing adverse events, is crucial to optimizing patient management.

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