Neuropsychiatric lupus and association with cerebrospinal fluid immunoglobulins: a pilot study.
BACKGROUND
Recent experimental evidence points to brain-reactive antibodies as a key factor in the pathogenesis of neuropsychiatric systemic lupus erythematosus (central nervous system-SLE). However, clinical studies in which circulating (serum) autoantibodies were correlated with neuropsychiatric manifestations have not produced consistent findings.


OBJECTIVE
To test the hypothesis that autoantibodies in cerebrospinal fluid are more reflective of functional brain damage.


METHODS
We compared the behavioral profiles of 12 NP-SLE patients, some of whom had immunoglobulin G in their CSF.


RESULTS
Western blotting revealed heavy and light chain IgG bands in six patients similar in age to the subgroup of CSF IgG-free patients. A series of serological measures did not differ between the subgroups, but SLEDAI scores and daily steroid doses were higher in patients with IgG in their CSF. All three patients with severe deficits in verbal and executive functions were positive for the CSF IgG, while three other patients with psychosis were CSF IgG-negative.


CONCLUSIONS
Although the present sample size is relatively small, the results support the relationship between disease severity and central manifestations of autoimmunity. They also emphasize the importance of clinical studies that compare subpopulations of NP-SLE patients and justify development of animal models in which controlled immune mechanisms induce specific deficits in behavior.
Stojanovich
Ljudmila
L
Department of Rheumatology, Bezanijska Kosa, University Medical Center, Belgrade.
Smiljanich-Miljkovich
Dusica
D
Omdal
Roald
R
Sakic
Boris
B
D000328:Adult; D001323:Autoantibodies / Q000134:cerebrospinal fluid*; D001927:Brain Diseases / Q000209:etiology* / Q000276:immunology; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology* / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid*; D020945:Lupus Vasculitis, Central Nervous System / Q000134:cerebrospinal fluid* / Q000150:complications / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010865:Pilot Projects; D011594:Psychometrics; D011618:Psychotic Disorders / Q000209:etiology* / Q000276:immunology
D001323:Autoantibodies; D007074:Immunoglobulin G
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