title: Systemic lupus erythematosus-associated acute transverse myelitis: manifestations, treatments, outcomes, and prognostic factors in 20 patients.
abstract: BACKGROUND
  Transverse myelitis is a rare complication of systemic lupus erythematosus (SLE). This retrospective multicentre study identifies the prognostic factors in a relatively large patient series.
  
  
  METHODS
  Twenty patients fulfilled the SLE criteria of the ACR classification and the Transverse Myelitis Consortium Working Group. A severe neurological flare was defined as muscle strength grade <3/5 in more than half the muscle groups at the motor neurological level. Inability to run or another significant ambulation-unrelated disability was considered as 'unfavourable neurological outcome'.
  
  
  RESULTS
  Myelitis was the first SLE symptom in 12 patients; in the eight others, it occurred 8.6 years (median delay) after SLE onset. Eleven patients presented severe neurological impairments. The treatment included corticosteroids in all patients associated with intravenous cyclophosphamide in 11 and/or hydroxychloroquine in 14. Unfavourable outcomes were observed in 53% of the patients at six months and in 28% at end of follow-up (median: 5.9 years). An initial severe neurological impairment and no cyclophosphamide use were associated with unfavourable neurological outcomes at six months and at end of follow-up, respectively.
  
  
  CONCLUSIONS
  Transverse myelitis may reveal SLE or occur more than 10 years after SLE diagnosis. The initial severity of the neurological flare (with paraplegia) is the main prognostic marker. The study provides arguments for cyclophosphamide use.
authors.affiliation: Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université de Lyon, Université Lyon 1, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Saison
authors.affiliation: Centre maladies rares, Service de médecine interne, Hôpital Cochin, Paris, France Université Paris Descartes, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: Université de Lyon, Université Lyon 1, Lyon, France Service de Biostatistique, Hospices Civils de Lyon, Lyon, France CNRS UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France.
authors.forename: D
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Université de Lyon, Université Lyon 1, Lyon, France Service de Biostatistique, Hospices Civils de Lyon, Lyon, France CNRS UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France.
authors.forename: J
authors.initials: J
authors.lastname: Iwaz
authors.affiliation: Département de Neurologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.
authors.forename: R
authors.initials: R
authors.lastname: Marignier
authors.affiliation: i3 Immunologie-Immunopathologie-Immunotherapie, (UMR 7211-Université Pierre et Marie Curie/CNRS, INSERM U 959), Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Cacoub
authors.affiliation: Département de Médecine Interne, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Vital-Durand
authors.affiliation: Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Hot
authors.affiliation: Département de Rhumatologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
authors.forename: J
authors.initials: J
authors.lastname: Tebib
authors.affiliation: Département de Médecine Interne, CHU Gabriel-Montpied, Clermont-Ferrand, France.
authors.forename: O
authors.initials: O
authors.lastname: Aumaitre
authors.affiliation: Département de Médecine Interne, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: N
authors.initials: N
authors.lastname: Schleinitz
authors.affiliation: Département de Médecine Interne, Hôpital Albert Michalon, Grenoble, France.
authors.forename: F
authors.initials: F
authors.lastname: Sarrot-Reynauld
authors.affiliation: Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université de Lyon, Université Lyon 1, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Broussolle
authors.affiliation: Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université de Lyon, Université Lyon 1, Lyon, France pascal.seve@chu-lyon.fr.
authors.forename: P
authors.initials: P
authors.lastname: Sève
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009188:Myelitis, Transverse / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine; D003520:Cyclophosphamide
keywords: Systemic lupus erythematosus; antiphospholipid syndrome; cyclophosphamide; hydroxychloroquine; myelitis; neuromyelitis optica