Neuropsychiatric Systemic Lupus Research Articles

Structural and Functional Characterization of Gray Matter Alterations in Female Patients With Neuropsychiatric Systemic Lupus.

ObjectiveTo investigate morphological and functional alterations within gray matter (GM) in female patients with neuropsychiatric systemic lupus (NPSLE) and to explore their clinical significance.Methods54 female patients with SLE (30 NPSLE and 24 non-NPSLE) and 32 matched healthy controls were recruited. All subjects received a quantitative MRI scan (FLAIR, 3DT1, resting-state functional MRI). GM volume (GMV), fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree of centrality (DC) were obtained. Between-group comparison, clinical correlation, and discrimination of NPSLE from non-NPSLE were achieved by voxel-based analysis, cerebellar seed-based functional connectivity analysis, regression analysis, and support vector machine (SVM), respectively.ResultsPatients with NPSLE showed overt subcortical GM atrophy without significantly abnormal brain functions in the same region compared with controls. The dysfunction within the left superior temporal gyri (L-STG) was found precede the GM volumetric loss. The function of the nodes in default mode network (DMN) and salience network (SN) were weakened in NPSLE patients compared to controls. The function of the cerebellar posterior lobes was significantly activated in non-NPSLE patients but attenuated along with GM atrophy and presented higher connectivity with L-STG and DMN in NPSLE patients, while the variation of the functional activities in the sensorimotor network (SMN) was the opposite. These structural and functional alterations were mainly correlated with disease burden and anti-phospholipid antibodies (aPLs) (r ranges from -1.53 to 1.29). The ReHos in the bilateral cerebellar posterior lobes showed high discriminative power in identifying patients with NPSLE with accuracy of 87%.ConclusionPatients with NPSLE exhibit both structural and functional alterations in the GM of the brain, which especially involved the deep GM, the cognitive, and sensorimotor regions, reflecting a reorganization to compensate for the disease damage to the brain which was attenuated along with pathologic burden and cerebral vascular risk factors. The GM within the left temporal lobe may be one of the direct targets of lupus-related inflammatory attack. The function of the cerebellar posterior lobes might play an essential role in compensating for cortical functional disturbances and may contribute to identifying patients with suspected NPSLE in clinical practice.

Shared pathological mechanisms of systemic lupus erythematosus and affective disorders

The high prevalence and variability of neurological and psychiatric symptoms in systemic lupus erythematosus has become the basis for emphasizing the special neuropsychiatric form of the disorder. Affective disorders (pathological changes in mood and anxiety) are the second most common neuropsychiatric manifestations in patients with systemic lupus erythematosus. However, the current nomenclature primarily focuses on the general clinical manifestations of affective disorders in neuropsychiatric form systemic lupus erythematosus, without evaluating the problems of their etiopathogenesis. Thereby, the aim of this review is the integration of information on the pathological mechanisms of depression and anxiety in patients with systemic lupus erythematosus. The available data on the biological aspects of the anxiety and depression in systemic lupus erythematosus indicate that the complex pathological models may be the best approach for studying, diagnosing, and treating comorbid pathology. The latter can be based on expanding the existing clinical categories, supplementing them with data on pathological mechanisms specific to particular sub-cohorts of patients. Such an approach can provide the specific and most effective preventive, diagnostic and therapeutic measures for each category of patients.

DNA hydrolysing IgG catalytic antibodies: an emerging link between psychoses and autoimmunity

It is not uncommon to observe autoimmune comorbidities in a significant subset of patients with psychotic disorders, namely schizophrenia (SCZ) and bipolar disorder (BPD). To understand the autoimmune basis, the DNA abyzme activity mediated by serum polyclonal IgG Abs were examined in psychoses patients, quantitatively, by an in-house optimized DNase assay. A similar activity exhibited by IgG Abs from neuropsychiatric-systemic lupus erythematosus (NP-SLE) patients was used as a comparator. Our data revealed that the IgG DNase activity of SCZ was close to that of NP-SLE and it was twofold higher than the healthy controls. Interestingly, the association between DNase activity with PANSS (positive, general and total scores) and MADRS were noted in a subgroup of SCZ and BPD patients, respectively. In our study group, the levels of IL-6 and total IgG in BPD patients were higher than SCZ and healthy controls, indicating a relatively inflammatory nature in BPD, while autoimmune comorbidity was mainly observed in SCZ patients.

Clinical analysis of neuropsychiatric systemic lupus erythematosus involving the central nervous system

Background Neuropsychiatric systemic lupus erythematosus (NP-SLE) presents with a wide variety of clinical manifestations, which is often difficult to diagnose with a high mortality. This study aims to investigate the clinical features of NP-SLE involving the central nervous system (CNS) and the differential diagnoses between CNS NP-SLE and intracranial infections. Methods The clinical manifestations, serum immunological features, cerebrospinal fluid (CSF) examinations (including intracranial pressure, leukocyte count, protein, glucose and chloride), CT and (or) MRI and electroencephalogram (EEG) data of 23 NP-SLE patients with CNS involved were retrospectively reviewed. Results Nine patients presented with diffuse manifestations, while 14 patients presented with focal manifestations. Serum analysis showed the positive rates of immunoglobulins anti-nuclear antibody (ANA), anti-double stranded DNA antibody (dsDNA), anti-Sm, anti-ribosmal P protein, anti-SSA and anti-SSB antibodies were 21/22, 7/22, 1/14, 2/14, 9/14 and 3/14 respectively. Patients with decreased serum C3 accounted for 14/20 while patients with decreased serum C4 accounted for 5/20. Besides, patients with increased CSF leukocyte count and microalbumin took up 5/12 and 7/12, while patients with decreased glucose and chloride levels took up 5/12 and 6/12. All 23 patients presented abnormal CT and (or) MRI and 6 patients presented abnormal EEG. Conclusion Serum immunological levels, CT and (or) MRI and EEG examinations contributed to the diagnosis of NP-SLE involving CNS. Although CSF analyses were slightly abnormal, the increase of leukocyte count and average microalbumin was not obvious, and the mean values of glucose and chloride were in the normal range, suggesting that the CSF examinations were helpful for the differential diagnoses from intracranial infections. Glucocorticoids and immunosuppressive drugs were remarkably effective for CNS NP-SLE patients.

Atypical Presentation of Neuropsychiatric Lupus With Acanthosis Nigricans

Cutaneous manifestations are commonly observed in pediatric patients with systemic lupus erythematosus. Acanthosis nigricans, however, is rarely reported, and even less often in association with neuropsychiatric manifestations of lupus erythematosus. We describe a 9-year-old boy with acute behavioral and cognitive deterioration, combined with cutaneous, diffuse hyperpigmented and hyperkeratotic plaques. Cerebral magnetic resonance imaging revealed cortical atrophy and white matter abnormalities involving the fornix, corpus callosum, and parieto-occipital periventricular regions. The presence of progressive cognitive and behavioral deterioration, combined with abnormal white matter signals on magnetic resonance imaging, led us to suspect X-linked adrenoleukodystrophy. The subsequent development of systemic signs, together with positive serologic tests, confirmed the diagnosis of neuropsychiatric lupus with acanthosis nigricans. We review the literature on acanthosis nigricans in systemic lupus erythematosus and the value of magnetic resonance imaging in evaluating patients with neuropsychiatric systemic lupus.

Progress of diagnosis and treatment for neuropsychiatric systemic lupus erythematosus

狼疮性脑病是指系统性红斑狼疮神经系统损害相关的神经精神表现,其发病率各家报道差异较大.它可发牛于系统性红斑狼疮的任何时期,临床症状呈多样化,为头痛、昏迷、抽搐、脑神经麻痹及精神症状多见.脑脊液、血清学以及影像学检查具有辅助诊断价值.其治疗应个体化,因人而异.长期专科随访甚为重要。

Observation and nursing intervention of neuropsychiatric systemic lupus erythematosus

目的 探讨神经精神性狼疮(NPSLE)的临床特点和护理措施.方法对25例NPSLE患者的临床观察和护理进行回顾性总结.结果23例好转出院,2例死亡.结论观察细致、掌握特点及操作熟练是护理NPSLE患者的关键;加强基础护理及消毒隔离能有效预防各种并发症,降低死亡率;健康教育能够提高患者治疗依从性,降低复发率。