RESEARCH - Neuropsychiatric syndromes in patients with SLE and primary Sjogren syndrome

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Published Online First: 17 October 2008. doi:10.1136/ard.2008.098301

ls of the Rheumatic Diseases 2009;68:1541-1546

Extended report

Neuropsychiatric syndromes in patients with systemic lupus

erythematosus and primary Sjögren syndrome: a comparative

population-based study

E Harboe1, A B Tjensvoll2, S Maroni3, L G Gøransson1,8, O J Greve4, M

K Beyer4, A Herigstad5, J T Kvaløy6,7, R Omdal1,8

1 Clinical Immunology Unit, Department of Internal Medicine, Stavanger

University Hospital, Stavanger, Norway

2 Department of Neurology, Stavanger University Hospital, Stavanger, Norway

3 Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway

4 Department of Radiology, Stavanger University Hospital, Stavanger, Norway

5 Department of Neurophysiology, Stavanger University Hospital,

Stavanger, Norway

6 Division of Research and Human Resources, Stavanger University

Hospital, Stavanger, Norway

7 Stavanger University Hospital, Department of Mathematics and Natural

Sciences, University of Stavanger, Stavanger, Norway

8 Institute of Internal Medicine, University of Bergen, Norway

Objectives: To compare the prevalence and pattern of neuropsychiatric

(NP) syndromes observed in systemic lupus erythematosus (SLE) to

patients with Primary Sjögren syndrome (PSS) using the American

College of Rheumatology (ACR) criteria for the 19 NP syndromes seen in

SLE.

Methods: A population-based study was conducted including 68 patients

with SLE (mean (SD) age 43.8 (13.6) years) and 72 with PSS (age 57.8

(13.0) years). Specialists in internal medicine, neurology and

neuropsychology performed standardised examinations. Cerebral MRI

scans and neurophysiological studies were performed in all patients.

Results: Similar prevalences in SLE and PSS were observed for

headaches (87% vs 78%, p = 0.165), cognitive dysfunction (46% vs 50%,

p = 0.273), mood disorders (26% vs 33%, p = 0.376), anxiety disorders

(12% vs 4%, p = 0.095), cranial neuropathy (1% vs 4%, p = 0.339) and

seizure disorders (7% vs 3%, p = 0.208). Cerebrovascular disease was

more common in SLE than PSS (12% vs 3%, p = 0.049); but mononeuropathy

(0% vs 8%, p = 0.015) and polyneuropathy (18% vs 56%, p<0.001) were

less common in SLE than PSS. Other syndromes were rare or absent in

both patient groups.

Conclusions: Headache, cognitive dysfunction and mood disorders are

common in both diseases, but otherwise there are distinct differences

in NP involvement, with cerebrovascular diseases more prevalent in SLE

and neuropathies more common in PSS. This indicates that some NP

disease mechanisms are shared while others differ between the two

diseases.

http://ard.bmj.com/cgi/content/abstract/68/10/1541?etoc

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