Background/Purpose:  Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood.  The first line treatment is psychostimulant medications namely, methylphenidate, amphetamines, or their derivatives.  The more common side effects of psychostimulants noted in children or adolescents are insomnia, decreased appetite, weight loss, and headaches.  In recent years other side effects of these medications have been noted. Our aim was to study patients who have been prescribed psychostimulants and experienced vascular changes in the spectrum of symptoms that included color change, pain, numbness to hands and feet, or similar peripheral vascular symptoms that will be globally termed peripheral vasculopathies.  These symptoms are also seen in other autoimmune disorders therefore a secondary analysis of association with ANA positivity was also explored.

Methods:  A retrospective chart review was completed that was derived from patients seen in Children’s Hospital of Georgia’s Pediatric Rheumatology clinic that were referred with complaints of peripheral vasculopathies.  We searched for concurrent diagnosis of ADD/ADHD, and the use of various psychostimulants.  Data was analyzed using contingency tables to derive p-values from Fisher’s Exact Test, Pearson’s Chi-Square, and Likelihood Ratios.

Results:  Initial data collection was compiled using ICD-9 codes related to peripheral vasculopathy symptoms and psychostimulant medication usage in patients seen in the Pediatric Rheumatology Clinic over 15 months.  Patient charts were then reviewed for 1) type of psychostimulants 2) length of use, 3) description of symptoms, 4) Positive ANA, 5) other Rheumatologic diagnoses, and 6) family history.  Collectively 145 patients were identified in the initial data pool.  Patients were excluded if they were less than 5 years old, did not have a diagnosis of a perhipheral vasculopathy, not taking psychostimulants , or had a previous rheumatologic disease.  After all exclusions a total of 47 patients were used in data analysis.  Chi-Square values ranged from 9.98 to 16.76 producing p-values less than 0.05.  The null hypothesis in the test was taking psychostimulants and having symptoms of peripheral vasculopathy were independent of each other. Thus the null hypothesis was rejected concluding that the use of psychostimulants and presence of peripheral vasculopathy symptoms are related. 

Conclusion:  Our retrospective analysis demonstrated that there is a strong association between the use of psychostimulants and peripheral vasculopathy symptoms. The sample size in this analysis is larger than previously published literature thus reinforcing concern for vasculopathy as a significant side effect of psychostimulants. A larger controlled prospective study is needed to further establish the exact statistical co-relation.  In conclusion, the diagnosis of ADHD and prescribing of psychostimulant medications is on a rise.  Our study demonstrates the need of making prescribing physicians aware of this significant side effect so they may educate the families and also elucidate occurrence of new vascular symptoms from this patient population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/psychostimulant-induced-vasculopathy-a-retrospective-study-in-a-pediatric-rheumatology-clinic/