RESEARCH - Neuropsychiatric manifestations of SLE: prevalence and association with antiphospholipid antibodies

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J Rheumatol. 2003 May;30(5):985-92. Related Articles, Links

Neuropsychiatric manifestations in systemic lupus erythematosus: prevalence

and association with antiphospholipid antibodies.

Sanna G, Bertolaccini ML, Cuadrado MJ, Laing H, Khamashta MA, Mathieu A,

GR.

Lupus Research Unit, The Rayne Institute, London, UK.

OBJECTIVE: To apply the new American College of Rheumatology nomenclature

for neuropsychiatric systemic lupus erythematosus (NPSLE), determine the

prevalence of the different neuropsychiatric (NP) syndromes, and evaluate

which of these manifestations correlates with the presence of

antiphospholipid antibodies (aPL). Methods. Clinical, serological, and

imaging data of 323 consecutive patients with SLE were retrospectively

reviewed. Neuropsychometric testing was applied by a neuropsychologist.

Univariate and multivariate statistical analyses were applied to evaluate

the association between NP manifestations, magnetic resonance imaging (MRI)

abnormalities, and aPL. RESULTS: In total, 185 patients (57.3%) had NP

manifestations at any time during followup. Headache was the most frequent

manifestation, present in 78 patients (24%). Cerebrovascular disease (CVD)

was diagnosed in 47/323 patients (14.5%), with a total of 57 events. Mood

disorders were found in 54 (16.7%), cognitive disorders in 35 (10.8%), and

seizures in 27 patients (8.3%). Psychosis was diagnosed in 25 (7.7%),

anxiety disorder in 24 (3.7%), and acute confusional state in 12 patients

(3.7%). Less common manifestations were polyneuropathy, mononeuritis,

myasthenia gravis, cranial neuropathy, myelopathy, chorea, demyelinating

disease, and Guillain-Barre syndrome. The presence of aPL was associated

with NP manifestations (p < 0.001). Multivariate analysis showed that aPL

were independently associated with CVD (OR 6.17, 95% CI 2.94-12.9, p =

0.001), headache (OR 2.04, 95% CI 1.17-3.55, p = 0.01), and seizures (OR

2.89, 95% CI 1.18-7.10, p = 0.02). The presence of lupus anticoagulant (LAC)

was independently associated with white matter hyperintensity lesions on MRI

(OR 3.0, 95% CI 1.12-8.05, p = 0.027).

CONCLUSION: The new ACR criteria for NPSLE are useful to define NP

manifestations in SLE with accuracy. NP manifestations are significantly

associated with aPL. CVD, headache, and seizures were independently

associated with these antibodies.

PMID: 12734893

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

2734893

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