Neuropsychiatric manifestations in a consecutive cohort of systemic lupus erythematosus; a single center study

Abstract

To identify the prevalence and the possible risk factors of occurrence and severity of neuropsychiatric (NP) manifestations in systemic lupus erythematosus (SLE). This is a cross-sectional study. The assessment of SLE patients is based on rheumatologic, neurologic and psychiatric evaluation, immunoserologic testing, and cerebral magnetic resonance imaging (MRI). Factors associated with NP manifestations were explored using regression models. Of 84 SLE patients included in this study, 36 (42.9%) had neuropsychiatric manifestations. Among these 36 patients, 34 (94.4%) were female and two (5.6%) were male. The most frequent manifestations were mood disorders, headache and anxiety disorder. Of 36 patients with NP-SLE; 16 patients have severe NP manifestations (≥ 3 NP manifestations). In univariate analysis, the risk factors that associated with severe NP manifestations included more organ damage, cutaneous vasculitis, nephritis flare, the presence of antiphospholipid antibodies, particularly lupus anticoagulant and anti-cardiolipin immunoglobulin G (IgG aCL), abnormal MRI of the brain and aggressive use of immunosuppressives. However, in multiple regression analysis, nephritis, cutaneous vasculitis, and IgG aCL were the only risk factors of severe NP manifestations. Due to the high prevalence of NP manifestations and its severity in SLE patients, systematic assessment to provide prompt diagnosis, early recognition of risk factors and appropriate intervention for NP lupus are essential.