[Neuropsychiatric lupus erythematosus].
Neuropsychiatric involvement in patients with Systemic Lupus Erythematosus (SLE), first mentioned by Kaposi more than 100 years ago, still remains one of the main challenge facing rheumatologist and other physicians. The diagnosis of neuropsychiatric SLE (NPSLE) is complex not only because of the considerable prevalence variation (14-80%) but also because of the wide spectrum of NP manifestations. They vary from overt neurologic alterations (seizure, psychosis), to subtle abnormalities (neurocognitive dysfunctions). Different NP manifestations result from a variety of mechanisms including antibodies, vasculitis, thrombosis, hemorrhages and cytokine-mediated damages. Of note, despite the dramatic clinical manifestations, too often changes at the morphological neuroimaging techniques are minimal and non specific. There is no one diagnostic tool specific for NPSLE and diagnosis must be based on the combinated use of immunoserological tests, functional and anatomical neuroimaging and standardized specific criteria. Symptomatic, immunosuppressive and anticoagulant therapies are the main strategies available in the management of these patients. Therapy for CNS lupus should be adjusted according to the needs of the individual patients. The coming years promise to be an important time for the development of new neuroimaging techniques and for the study of disease mechanism. An early and objective identification of brain involvement will allow for appropriate treatment to avoid severe complications.
Vadacca
M
M
Dipartimento di Medicina Clinica, Immunologia, Reumatologia, Università Campus Bio-Medico, Roma, Italia.
Buzzulini
F
F
Rigon
A
A
Coppolino
G
G
Palma Modoni
A
A
Massa
R
R
Afeltra
A
A
D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017152:Antibodies, Antiphospholipid / Q000032:analysis; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008487:Medical History Taking; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D010956:Plasmapheresis; D015995:Prevalence; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D014151:Anti-Anxiety Agents; D017152:Antibodies, Antiphospholipid; D014150:Antipsychotic Agents; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008727:Methotrexate