[Neuropsychiatric manifestations in systemic lupus erythematosus and the treatment of intrathecal methotrexate plus dexamethasone].
OBJECTIVE
To study the neuropsychiatric (NP) manifestations of systemic lupus erythematosus (SLE) and evaluate treatment with intrathecal (IT) methotrexate (MTX) and dexamethasone (DXM).


METHODS
240 patients with NP syndromes of SLE (NPSLE) from 1990 to 2004 were retrospectively reviewed and IT injection group and non-IT injection group were compared. The side effects of IT injection were also discussed. 130 patients were followed up after discharge.


RESULTS
Fifteen of the 19 ACR NP syndromes were identified. 86 (35.8%) patients presented one NP syndrome and 154 (64.2%) presented with more than one. The most frequent manifestations were headache and seizure disorder. 109 patients received IT injections. After IT injection, the CSF index had significantly improved. The mean SLEDAI score, mean duration of hospitalization and mortality rate of patients with IT injection were lower than those patients without IT injection (P < 0.05 - 0.001). The side effects of IT injection were found in 11.0% patients. 23 of 130 patients had recurrent NP events during follow up.


CONCLUSIONS
There was heterogeneity of NPSLE in our study group. The most common NP features were headache and seizure. IT injection of MTX and DXM is an effective and safe alternative to traditional treatment of NPSLE.
Zhou
Hui-qiong
HQ
Department of Clinical Immunology & Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Leng
Xiao-mei
XM
Zhang
Feng-chun
FC