Abstract
Neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE) is a life-threatening disorder and early diagnosis and proper treatment are critical in the management of this neuropsychiatric manifestations in lupus. Brain magnetic resonance imaging (MRI), electroencephalogram (EEG), neuropsychological tests, and lumbar puncture are clinical used for the diagnosis of NPSLE. In addition to these tests, cytokine and chemokine levels in CSF have been reported as useful diagnostic marker of NPSLE. Based on the number of recently published studies, this review overviewed the roles of cytokines and chemokines in NPSLE.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by widespread immunologic abnormalities and multiorgan involvement, including the skin, joints, and kidney, as well as the peripheral and central nervous systems (CNS)
Increased levels of proinflammatory cytokines and chemokines have been reported in the cerebral spinal fluids (CSF) of patients with Neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE), and some reports have shown cytokines such as interleukin-6 (IL-6), IL-1, IL-8, IL-10, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, monocyte chemotactic protein 1 (MCP-1)/CCL2, Interferon-gamma inducible protein-10 (IP-10)/CXCL10 and Fractalkine/CX3CL1 to be elevated intrathecally, thereby allowing these cytokines to be used as diagnostic tools [5,6,7,8,9]
TNF-α may promote the pathogenesis of lupus, since the level of TNF-α messenger RNA was high in kidneybiopsy specimens from patients with lupus nephritis and there is a report showing that giving the anti- TNF-α antibody agent, infliximab, to six patients with lupus led to resolution of joint swelling in three patients with arthritis and a 60% reduction of urinary protein loss in four patients with renal lupus [10, 11]
Summary
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by widespread immunologic abnormalities and multiorgan involvement, including the skin, joints, and kidney, as well as the peripheral and central nervous systems (CNS). Neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE) may occur at any time during the course of the disease, and symptoms are extremely diverse, ranging from depression, psychosis, and seizures to stroke [1]. Along with more specific diagnostic tools and an effective method of monitoring disease activity, therapeutic responses are crucial in the management of NPSLE. Tests for diagnosing NPSLE include brain magnetic resonance imaging (MRI), electroencephalogram (EEG), neuropsychological tests, and lumbar puncture. These findings are reported to be abnormal in some but not all patients, and none of the findings are specific for NPSLE. The large discrepancy in thereported frequency of neuropsychiatric involvement in SLE patients (14%–75%) further proves there is no single confirmatory diagnostic tool [3, 4]. Based on the number of recently published studies, this review focuses on the cytokines and chemokines as biomarkers as well as pathogenic factors in NPSLE
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