Abstract
ObjectiveTo examine for presence of subclinical neuropsychiatric lupus and cerebral atherosclerosis and their correlation with MRI/magnetic resonance angiography (MRA) findings and disease activity and to find if these radiological changes compared with laboratory parameters could be predictive of the early NP affection aiming for early management of these dysfunctions.Patients and methodsThirty adult female patients with systemic lupus erythematosus (SLE) were enrolled, with assessment of SLE disease activity using Systemic Lupus Erythematosus Disease Activity Index; psychometric evaluations using the Modified Mini-Mental State Examination to assess for cognitive dysfunction; Hamilton Depression Rating Scale and Hamilton Anxiety Scale to assess for depression and anxiety, respectively; and brain MRI/MRA to detect any changes in subclinical cases.ResultsThe mean age was 31.7 years. Twelve (40%) patients had positive antiphospholipid (aPL) antibodies with or without clinically evident antiphospholipid syndrome, 22 (73.33%) had different NP manifestations, 13 (43.3%) depression, 15 (50%) anxiety, and 16 (53.3%) cognitive dysfunction. All patients with depression and anxiety and 87.5% of patients with dementia showed abnormalities on MRI. All patients with positive aPL showed abnormalities on MRI, whereas abnormalities on MRI were found in only eight patients with SLE with negative aPL (100 vs. 44.4%). There was a significant correlation between SLE disease activity and both NP manifestations and abnormalities on MRI/MRA, and also between aPL antibodies and NP manifestations. Abnormalities on MRI included discrete white matter lesions, cortical atrophy, and gross infarctions.ConclusionSignificant number of patients with SLE without overt NP manifestations had subclinical cerebrovascular and cognitive dysfunctions, depression, and anxiety by simple bedside questionnaires. SLE disease activity positively correlates with NP manifestations. The presence of aPL antibodies is a strong risk factor for developing NP SLE. Several distinct brain MRI patterns were observed in patients with active NP SLE, suggestive of different pathogenic mechanisms.
Highlights
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease where autoantibodies result in tissue injury [1]
Patients were considered positive for Neuropsychiatric systemic lupus erythematosus (NPSL) by having at least one of the three main NP manifestations: anxiety, depression, and/or dementia
We found that 46% of patients with SLE with depression (n=13) were found to have different magnetic resonance angiography (MRA) abnormalities, whereas MRA abnormalities were found in only one patient with SLE without depression (46 vs. 6%) (P=0.008), with a statistically significant higher mean Hamilton Depression Rating Scale (HAM-D) among patients with abnormal MRA findings than that in patients with SLE with normal MRA findings (17.7 vs. 14.7) (P=0.019)
Summary
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease where autoantibodies result in tissue injury [1]. Up to 50% of patients with SLE experience neurological involvement throughout the course of the disease [2]. In ∼40% of cases, neuropsychiatric (NP) manifestations are because of the disease itself. Other causes of NP manifestations are infections, metabolic disorders, and adverse effects of drugs [3]. Time during the course of the disease or may even precede its onset. NPSL can present during the active or quiescent phase of SLE [4]. NP manifestations result in impaired quality of life and high morbidity and mortality [5]. As no specific tests or biomarkers are available for establishing a diagnosis, the attribution of NP manifestations to SLE continues
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