RESEARCH - Autoantibodies and neuropsychiatric events at the time of SLE diagnosis

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Arthritis Rheum. 2008 Feb 29;58(3):843-853 [Epub ahead of print]

Autoantibodies and neuropsychiatric events at the time of systemic

lupus erythematosus diagnosis: Results from an international inception

cohort study.

Hanly JG, Urowitz MB, Siannis F, Farewell V, Gordon C, Bae SC,

Isenberg D, Dooley MA, e A, Bernatsky S, Gladman D, Fortin PR,

Manzi S, Steinsson K, Bruce IN, Ginzler E, Aranow C, Wallace DJ,

Ramsey-Goldman R, van Vollenhoven R, Sturfelt G, Nived O,

-Guerrero J, Alarcón GS, Petri M, Khamashta M, Zoma A, Font J,

Kalunian K, J, Qi Q, K, Merrill JT; Systemic Lupus

International Collaborating Clinics.

Queen II Health Sciences Centre, Halifax, Canada.

OBJECTIVE: To examine, in an inception cohort of systemic lupus

erythematosus (SLE) patients, the association between neuropsychiatric

(NP) events and anti-ribosomal P (anti-P), antiphospholipid (lupus

anticoagulant [LAC], anticardiolipin), anti-beta2-glycoprotein I, and

anti-NR2 glutamate receptor antibodies. METHODS: NP events were

identified using the American College of Rheumatology case definitions

and clustered into central/peripheral and diffuse/focal events.

Attribution of NP events to SLE was determined using decision rules of

differing stringency. Autoantibodies were measured without knowledge

of NP events or their attribution. RESULTS: Four hundred twelve

patients were studied (87.4% female; mean +/- SD age 34.9 +/- 13.5

years, mean +/- SD disease duration 5.0 +/- 4.2 months). There were

214 NP events in 133 patients (32.3%). The proportion of NP events

attributed to SLE varied from 15% to 36%. There was no association

between autoantibodies and NP events overall. However, the frequency

of anti-P antibodies in patients with central NP events attributed to

SLE was 4 of 20 (20%), versus 3 of 107 (2.8%) in patients with other

NP events and 24 of 279 (8.6%) in those with no NP events (P = 0.04).

Among patients with diffuse NP events, 3 of 11 had anti-P antibodies

(27%), compared with 4 of 111 patients with other NP events (3.6%) and

24 of 279 of those with no NP events (8.6%) (P = 0.02). Specific

clinical-serologic associations were found between anti-P and

psychosis attributed to SLE (P = 0.02) and between LAC and

cerebrovascular disease attributed to SLE (P = 0.038). There was no

significant association between other autoantibodies and NP events.

CONCLUSION: Clinically distinct NP events attributed to SLE and

occurring around the time of diagnosis were found to be associated

with anti-P antibodies and LAC. This suggests that there are different

autoimmune pathogenetic mechanisms, although low sensitivity limits

the clinical application of testing for these antibodies.

PMID: 18311802

http://www.ncbi.nlm.nih.gov/pubmed/18311802

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