Brain magnetic resonance imaging in newly diagnosed systemic lupus erythematosus.
OBJECTIVE
We wished to determine the prevalence of cerebral atrophy and focal lesions in a cohort of patients with newly diagnosed systemic lupus erythematosus (SLE) and the association of these brain abnormalities with clinical characteristics.


METHODS
A total of 97 patients with SLE, within 9 months of diagnosis, with 4 or more American College of Rheumatology classification criteria, were enrolled. Brain magnetic resonance imaging was performed.


RESULTS
The patients were 97% female, mean age 38.1 (SD 12.2) years, education 15.1 (2.8) years; 59 Caucasian, 11 African American, 19 Hispanic, 5 Asian, and 3 other ethnicity. Cerebral atrophy was prevalent in 18% (95% CI 11%-27%): mild in 12%, moderate in 5%. Focal lesions were prevalent in 8% (95% CI 4%-16%): mild in 2%, moderate in 5%, severe in 1%. Patients with cerebral atrophy were more likely to have anxiety disorder (p = 0.04). Patients with focal lesions were more likely to be African American (p = 0.045) and had higher Safety of Estrogens in Lupus Erythematosus National Assessment SLEDAI scores (p = 0.02) and anti-dsDNA (p = 0.05).


CONCLUSIONS
In this population with newly diagnosed SLE, brain abnormalities were prevalent in 25% of patients. These findings suggest that the brain may be affected extremely early in the course of SLE, even before the clinical diagnosis of SLE is made. Followup of these patients is planned, to determine the reversibility or progression of these abnormalities and their association with and potential predictive value for subsequent neuropsychiatric SLE manifestations.
Petri
Michelle
M
Johns Hopkins University, Baltimore, Maryland 21205, USA. mpetri@jhmi.edu
Naqibuddin
Mohammad
M
Carson
Kathryn A
KA
Wallace
Daniel J
DJ
Weisman
Michael H
MH
Holliday
Stephen L
SL
Sampedro
Margaret
M
Narayana
Shalini
S
Fox
Peter T
PT
Franklin
Crystal
C
Padilla
Patricia A
PA
Brey
Robin L
RL
D000328:Adult; D001284:Atrophy; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
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