Clinical Factors Associated with Brain Volume Reduction in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations.

Shuang Liu,Jian Xu,Baoci Shan,Zhaoping Lv,Lin Xu,Hongjun Yu,Yueyin Zhao,Aiyun Lai,Xiufeng Xu,Chunrong Luo,Yuqi Cheng

doi:10.3389/fpsyt.2018.00008

Abstract

The aim of the study was to find structural brain changes in systemic lupus erythematosus patients without major neuropsychiatric manifestations [non-neuropsychiatric systemic lupus erythematosus (non-NPSLE)] using quantitative magnetic resonance imaging (MRI) and possible associations with clinical characteristics. 89 non-NPSLE patients with normal conventional MRI and 84 healthy controls (HCs) were recruited. The whole brain gray matter volume (GMV) and white matter volume (WMV) were calculated for each individual. We found obvious GMV and WMV reduction in the systemic lupus erythematosus (SLE) group compared with HCs. Female patients showed significant reduction of GMV and WMV compared with male patients. Patients treated with immunosuppressive agents (ISA) showed less WMV reduction than those without. Cognitive impairment was the most common subclinical neuropsychiatric manifestation and had a prevalence of 46.1%. Association between WMV reduction with cognitive impairment was found. Thus, we concluded that structural brain atrophy could happen even before occurrence of obvious neuropsychiatric signs and symptoms and was associated with subclinical symptoms such as cognitive impairment. ISA treatment might have a protective effect on the brain atrophy. Early treatment might prevent the progressive damage to the brain. More studies are needed to fully understand the complicated underlying mechanisms of brain atrophy in SLE.

Highlights

Systemic lupus erythematosus (SLE) is an autoimmune disease involving almost all organ systems
There is evidence that abnormal white matter (WM) structures were found by Magnetic resonance imaging (MRI) volumetrics in SLE patients without major neuropsychiatric manifestations, i.e., non-neuropsychiatric SLE (NPSLE) patients and SLE patients with normal conventional brain MRI, suggesting that structural abnormalities could happen before obvious Central nervous system (CNS) manifestations [8]
We found significant gray matter volume (GMV) and white matter volume (WMV) reductions in non-NPSLE patients who had normal conventional MRI with significant gender differences

Summary

Introduction

Systemic lupus erythematosus (SLE) is an autoimmune disease involving almost all organ systems. Brain atrophy, which has long been reported in SLE using neuroimaging techniques, often correlates with clinical manifestations, even in patients without obvious CNS signs and symptoms [3, 4]. Conventional or anatomical MRI findings are sometimes non-specific and can be negative in neuropsychiatric SLE (NPSLE) patients [7]. There is evidence that abnormal white matter (WM) structures were found by MRI volumetrics in SLE patients without major neuropsychiatric manifestations, i.e., non-NPSLE patients and SLE patients with normal conventional brain MRI, suggesting that structural abnormalities could happen before obvious CNS manifestations [8]. If subclinical brain structure involvement could be identified before the emergence of obvious neuropsychiatric symptoms, earlier intervention could be initiated, potentially preventing progression of brain injury

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