Abstract
ObjectiveTo determine if cognitive dysfunction in patients with systemic lupus erythematosus (SLE) derives from an inflammatory process with continuing disease activity, and increased levels of autoantibodies and inflammatory molecules in serum and cerebrospinal fluid (CSF).Methods100 randomly selected patients participating in an inception SLE cohort were studied. At entry into the cohort, a standardized medical history and extensive laboratory tests profile, including autoantibodies were completed. Follow-up occurred every 3–6 months with assessment of lupus characteristics, comorbidities, and treatment. After a mean follow-up of six-years, cross-sectional evaluation of cognitive function was done with standardized tests, and in a subset of patients an extended profile of autoantibodies, cytokines and chemokines was measured in serum and CSF.ResultsAt enrollment into the cohort, patients were 26.4±8.2 years of age and lupus duration 5.3±3.7 months. Moderate/severe cognitive dysfunction was diagnosed in 16 patients; in comparison to patients with normal cognitive function, they had lower education 9 vs. 12 years (P = 0.006), higher body mass index 26.7 vs. 24.3 (P = 0.03), positive IgG anticardiolipin antibodies 50% vs 18% (P = 0.009), and a higher median number of concomitant NPSLE syndromes 3 vs. 1, (P = 0.04). The prevalence of cardiovascular-risk factors, other auto-antibodies, lupus activity, treatment, and incidence of critical events did not differ. In serum and CSF, the levels of autoantibodies, cytokines and chemokine were similar, only CCL2 was elevated in CSF [886.1 (374.9–1439.7) vs. 515.8 (3.2–1958.2) pg/mL, P = 0.04].ConclusionScant evidence of inflammation in SLE patients with cognitive dysfunction was observed. Only a higher prevalence of IgG anticardiolipin antibodies in serum and increased levels of CCL2 in CSF were detected.
Highlights
Cognitive dysfunction is one of the 19 neuropsychiatric syndromes affecting patients with systemic lupus erythematosus [1]
Moderate/severe cognitive dysfunction was diagnosed in 16 patients; in comparison to patients with normal cognitive function, they had lower education 9 vs. 12 years (P = 0.006), higher body mass index 26.7 vs. 24.3 (P = 0.03), positive IgG anticardiolipin antibodies 50% vs 18% (P = 0.009), and a higher median number of concomitant NPSLE syndromes 3 vs. 1, (P = 0.04)
A higher prevalence of IgG anticardiolipin antibodies in serum and increased levels of CCL2 in cerebrospinal fluid (CSF) were detected
Summary
Cognitive dysfunction is one of the 19 neuropsychiatric syndromes affecting patients with systemic lupus erythematosus [1]. The reported prevalence 15–81%, severity, course, and impact of cognitive dysfunction are greater in patients with SLE than in the general population and patients with rheumatoid arthritis, suggesting that SLE itself contributes to cognitive dysfunction [2,3,4,5,6,7,8]. In comparison to rheumatoid arthritis, severe cognitive dysfunction develops in SLE more often, despite demographic features, cardiovascular risk factors, mean daily steroid dosage, prevalence and mean scores of anxiety and depression are similar, suggesting that generic risk factors for impairment play a more relevant role in SLE [2,6,7,8]. Cognitive dysfunction has been associated to antiphospholipid antibodies, antiNR2 antibodies, lower education, disease activity, chronic damage, hypertension, stroke, and corticosteroid use, these results are inconsistent [2,5,6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
