title: Pharmacologic management of neuropsychiatric lupus.
abstract: Neuropsychiatric lupus affects above 50% of patients with systemic lupus erythematosus and may span from mild symptoms to acute devastating life-threatening ones. Owing to the clinical variability, most pharmacological data rely on small, uncontrolled trials and case reports. The mainstay of therapy relies on immune-suppression by glucocorticoids, in adjunction with cyclophosphamide or anti-B-cell therapy, in moderate to severe cases. In selected scenarios (e.g., chorea) intravenous immunoglobulin or plasmapheresis may be effective. Anticoagulation is warranted if anti-phospholipid antibodies are present. In parallel there may be a need for symptomatic treatment such as anti-epileptic or anti-depressive treatments, etc. In the future, more studies addressed to assess pathogenesis and preferred treatments of specific manifestations are needed in order to personalize treatments.
authors.affiliation: a The Zabludowicz Center for Autoimmune Diseases , The Chaim Sheba Medical Center, Tel-Hashomer , Ramat-Gan , Israel.|b Rheumatology Unit, The Chaim Sheba Medical Center , Tel Hashomer , Ramat-Gan , Israel.|c Department of Medicine 'A', The Chaim Sheba Medical Center , Tel Hashomer , Ramat-Gan , Israel.|d The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, The Chaim Sheba Medical Center , Tel Hashomer , Ramat-Gan , Israel.
authors.forename: Shaye
authors.initials: S
authors.lastname: Kivity
authors.affiliation: a The Zabludowicz Center for Autoimmune Diseases , The Chaim Sheba Medical Center, Tel-Hashomer , Ramat-Gan , Israel.|e St Georges University of London/Nicosia Medical School , University of Nicosia , Egkomi , Cyprus.
authors.forename: Britain
authors.initials: B
authors.lastname: Baker
authors.affiliation: a The Zabludowicz Center for Autoimmune Diseases , The Chaim Sheba Medical Center, Tel-Hashomer , Ramat-Gan , Israel.|f Doctorate Program of Universidad del Rosario , Bogotá , Colombia.
authors.forename: Maria-Teresa
authors.initials: MT
authors.lastname: Arango
authors.affiliation: g Department of Neurology , Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer , Ramat Gan , Israel.|h Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel.
authors.forename: Joab
authors.initials: J
authors.lastname: Chapman
authors.affiliation: a The Zabludowicz Center for Autoimmune Diseases , The Chaim Sheba Medical Center, Tel-Hashomer , Ramat-Gan , Israel.|h Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel.|i Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases , Tel-Aviv University , Tel-Aviv , Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D000818:Animals; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D020945:Lupus Vasculitis, Central Nervous System / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D010956:Plasmapheresis / Q000379:methods
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: Anti-ribosomal P antibodies; cyclophosphamide; depression; neuropsychiatric lupus; systemic lupus erythematosus