Neuropsychiatric manifestations and magnetic resonance spectroscopy of the brain in systemic lupus erythematosus patients

Abstract

BackgroundNeuropsychiatric manifestations of lupus (NPSLE) are considered one of the major and most devastating lupus manifestations. The aim of this study was to assess the neuropsychiatric manifestations in systemic lupus erythematosus (SLE) patients and estimate the effectiveness of brain magnetic resonance spectroscopy (MRS) and anti-ribosomal P antibody test in early detection of NPSLE. This cross-sectional study was carried out on 50 SLE patients. Demographic, clinical, and therapeutic data were assessed. All patients were subjected to thorough rheumatological and neuropsychiatric evaluation. Serologic tests included antinuclear antibodies, anti-double-stranded DNA, and anti-ribosomal P protein antibodies. Radiologic evaluation included brain MRS.ResultsThe mean age was 26.9 ± 98.9 years; the median disease duration was 18 (0–108) months. Headache was the most common neurological symptom (40%). Depression was not detected in 29 patients (58%), mild in 15 patients (30%), and moderate in 6 patients (12%). Anti-ribosomal P antibody titer was significantly elevated in patients with active in comparison with those with inactive lupus disease (p = 0.026). Brain MRS showed a statistically significant reduction in N-acetylaspartate creatine ratio (NAA/Cr) among patients with active lupus disease (p = 0.015) with a statistically significant increase in choline creatine ratio (Cho/Cr) among patients with inactive lupus disease (p = 0.049). There was a statistically significant negative correlation between the level of NAA/Cr and anti-ribosomal P antibody titer among patients with active lupus disease (p < 0.001).ConclusionsHeadache is the most common neurological manifestation among SLE patients. Anti-ribosomal P antibody titer is elevated in active SLE patients. The changes of NAA/Cr and Cho/Cr in brain MRS can be of help to differentiate between the active and inactive SLE.