The Interface Between Medicine and Psychiatry: Neuropsychiatric Aspects of Systemic Lupus Erythematosus (SLE)

Abstract

1Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 2Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Address for Correspondence: Dr Roger C Ho, Department of Psychological Medicine, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228. Email: pcmrhcm@nus.edu.sg Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease characterised epidemiologically by the preponderance of women, and pathologically by the loss of immunological tolerance to self-nuclear antigens and aberrant Band T-cell responses.1,2 Similar to that of other regions around Southeast Asia, the prevalence of SLE in Singapore is 40/100,000.3 Amongst various organ involvement, neuropsychiatric SLE (NPSLE) is one of the most devastating presentations of the condition.4 NPSLE is likely the result of the interplay amongst the immunopathological actions of autoantibodies, intrathecal infl ammatory mediators and cerebral microvasculopathy.5 The American College of Rheumatology (ACR) Ad Hoc Committee devised case defi nitions for 19 neuropsychiatric syndromes in SLE which comprise central and peripheral neurological, and psychiatric syndromes such as anxiety, depression and cognitive dysfunction.6 Irreversible organ damage, which potentially occurs when lupus-induced damage persists for more than 6 months, does not spare the neuropsychiatric system. Indeed, damage to the neuropsychiatric system has been dragging down the 5-year and 10-year survival rates of lupus patients over the past 50 years,7 in addition to the substantial socioeconomic burden it entails for those who survive.8