Neuropsychiatric manifestations in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies.
OBJECTIVE
To apply the new American College of Rheumatology nomenclature for neuropsychiatric systemic lupus erythematosus (NPSLE), determine the prevalence of the different neuropsychiatric (NP) syndromes, and evaluate which of these manifestations correlates with the presence of antiphospholipid antibodies (aPL). Methods. Clinical, serological, and imaging data of 323 consecutive patients with SLE were retrospectively reviewed. Neuropsychometric testing was applied by a neuropsychologist. Univariate and multivariate statistical analyses were applied to evaluate the association bewteen NP manifestations, magnetic resonance imaging (MRI) abnormalities, and aPL.


RESULTS
In total, 185 patients (57.3%) had NP manifestations at any time during followup. Headache was the most frequent manifestation, present in 78 patients (24%). Cerebrovascular disease (CVD) was diagnosed in 47/323 patients (14.5%), with a total of 57 events. Mood disorders were found in 54 (16.7%), cognitive disorders in 35 (10.8%), and seizures in 27 patients (8.3%). Psychosis was diagnosed in 25 (7.7%), anxiety disorder in 24 (3.7%), and acute confusional state in 12 patients (3.7%). Less common manifestations were polyneuropathy, mononeuritis, myasthenia gravis, cranial neuropathy, myelopathy, chorea, demyelinating disease, and Guillain-Barré syndrome. The presence of aPL was associated with NP manifestations (p < 0.001). Multivariate analysis showed that aPL were independently associated with CVD (OR 6.17, 95% CI 2.94-12.9, p = 0.001), headache (OR 2.04, 95% CI 1.17-3.55, p = 0.01), and seizures (OR 2.89, 95% CI 1.18-7.10, p = 0.02). The presence of lupus anticoagulant (LAC) was independently associated with white matter hyperintensity lesions on MRI (OR 3.0, 95% CI 1.12-8.05, p = 0.027).


CONCLUSIONS
The new ACR criteria for NPSLE are useful to define NP manifestations in SLE with accuracy. NP manifestations are significantly associated with aPL. CVD, headache, and seizures were independently associated with these antibodies.
Sanna
Giovanni
G
Lupus Research Unit, The Rayne Institute, London, UK.
Bertolaccini
Maria L
ML
Cuadrado
Maria J
MJ
Laing
Hana
H
Khamashta
Munther A
MA
Mathieu
Alessandro
A
Hughes
Graham R V
GR
D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood*; D003072:Cognition Disorders / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D015331:Cohort Studies; D004827:Epilepsy / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood*; D020945:Lupus Vasculitis, Central Nervous System / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D015999:Multivariate Analysis; D015995:Prevalence; D011594:Psychometrics
D017153:Antibodies, Anticardiolipin; D016682:Lupus Coagulation Inhibitor