Evaluation of Neurological Manifestations of Systemic Lupus Erythematosus
DOI:
https://doi.org/10.32007/jfacmedbagdad.2124Keywords:
Neuropsychiatric, Systemic Lupus ErythematosusAbstract
Abstract
Background: Neuropsychiatric symptoms are typical consequences in patients with systemic lupus erythematosus (SLE). There is no apparent link between the clinical parameters of SLE patients and the development of neuropsychiatric symptoms.
Objectives: to determine the incidence of neurological manifestations and the risks associated with them in SLE patients.
Patients and Methods: This is a case-series study comprised 65 patients who visited the rheumatology Department at Baghdad Teaching Hospital/Medical City between January 2022 and February 2023. All patients' demographic and clinical data, including age, gender, disease duration, type and duration of treatment, general signs of the disease, and neurological and psychiatric manifestations of SLE, were collected. Laboratory data comprised plasma anti-phospholipid antibodies (aPL), anti-double stranded DNA (anti-dsDNA), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The cognitive dysfunction was assessed using the six-item cognitive impairment test (6CIT).
Results: Out of 65 patients, 34 (52.3%) were found to have at least one neuropsychiatric SLE (NPSLE) manifestation. Headache and depression were the most common NPSLE manifestation encountered in 36 patients (55.4%) followed by psychosis (21.5%), neuropathy (16.9%) and stroke and seizure (13.5%). In multivariate analysis, each of age >35 years (OR= 2.92, 95%CI= 1.12-34.2, p= 0.10), disease duration >5 years (4.45, 95%CI=1.23-28.43, p= 0.001), anti-phospholipid Abs (OR= 4.22, 95%CI= 1.17-89.38, p= 0.036), lupus nephritis (OR= 6.34, 95%CI= 1.27- 64.98, p= 0.029) and 6CIT>3 (OR= 5.83, 95%CI= 1.55- 21.87, p= 0.009) are independent predictors for NPSLE in patients with SLE.
Conclusions: Neuropsychiatric manifestations developed in more than half of the SLE cases studied within up to six-year of disease duration. Headache and depression, psychosis and neuropathy are the most common NPSLE manifestations. Older age and longer disease duration are risk factors for development of NPSLE. Clinically, anti-phospholipid antibodies, lupus nephritis and a high score of the six-item cognitive impairment test (>8) are predictors for NPSLE.
Received: May, 2023
Accepted: Sept., 2023
Published: Jan., 2024
Downloads
References
The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999;42(4):599-608.
https://doi.org/10.1002/1529-0131(199904)42:4<599::AID-ANR2>3.0.CO;2-F.
Hanly JG, Urowitz MB, Su L. Prospective analysis of neuropsychiatric events in an international disease inception cohort of patients with systemic lupus erythematosus. Ann Rheum Dis 2010;69(3):529-535. https://doi.org/10.1136/ard.2008.106351.
Zhang L, Fu T, Yin R, Zhang Q, Shen B. Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis. BMC Psychiatry 2017;17(1):70 https://doi.org/10.1186/s12888-017-1234-1.
Kakati S, Barman B, Ahmed SU, Hussain M. Neurological Manifestations in Systemic Lupus Erythematosus: A Single Centre Study from North East India. J Clin Diagn Res. 2017 Jan;11(1):OC05-OC09. https://doi.org/10.7860/JCDR/2017/23773.9280.
Fan W, Zhou Z, Lu L. Clinical manifestations of neuropsychiatric systemic lupus erythematosus in Chinese patients. Arch Rheumatol 2014;29(2):88-93 https://doi.org/10.5606/ArchRheumatol.2014.4051.
Haghighi AB, Haza SG. Neuropsychiatric manifestations of systemic lupus erythematosus: Iranian experience. Ann Indian Acad Neurol. 2010 Apr;13(2):108-11. https://doi.org/10.4103/0972-2327.64633.
Bankole AA, Kazmi TR, Strazanac AR. Determination of the Risk Factors Contributing to the Development of Neuropsychiatric Lupus in a Systemic Lupus Erythematosus Cohort. Cureus. 2021 Dec 3;13(12):e20129. https://doi.org/10.7759/cureus.20129/.
Khan MI, Qureshi H, Akhtar S. Prevalence of neuropsychiatric disorders in patients with systemic lupus erythematosus in Pakistan: A systematic review and meta-analysis. Front. Psychiatry 2023;14:1098734. https://doi.org/10.3389/fpsyt.2023.1098734.
Brey RL, Holliday SL, Saklad. Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology. 2002 Apr 23;58(8):1214-20. https://doi.org/10.1212/WNL.58.8.1214.
Ainiala H, Loukkola J, Peltola J. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology. 2001 Aug 14;57(3):496-500. https://doi.org/10.1212/WNL.57.3.496.
Lessa B, Santana A, Lima I, Almeida JM, Santiago M. Prevalence and classifi cation of headache in patients with systemic lupus erythematosus. Clin Rheumatol 2006;25:850-3. https://doi.org/10.1007/s10067-005-0186-x.
Krishnan E. Stroke subtypes among young patients with systemic lupus erythematosus. Am J Med. 2005;118: 1415. https://doi.org/10.1016/j.amjmed.2005.05.026.
Ward MM. Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythtematosus. Arthritis Rheum 1999; 42:338-46. https://doi.org/10.1002/1529-0131(199902)42:2<338::AID-ANR17>3.0.CO;2-U.
Ainiala H, Loukkola J, Peltola J. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology. 2001 Aug 14;57(3):496-500. https://doi.org/10.1212/WNL.57.3.496.
Bortoluzzi A, Piga M, Silvagni E. Peripheral nervous system involvement in systemic lupus erythematosus: a retrospective study on prevalence, associated factors and outcome. Lupus. 2019 Apr;28(4):465-474. https://doi.org/10.1177/0961203319828499.
Karassa FB, Ioannidis JP, Touloumi G, Boki KA, Moutsopoulos HM. Risk factors for central nervous system involvement in systemic lupus erythematosus. QJM. 2000 Mar;93(3):169-74. https://doi.org/10.1093/qjmed/93.3.169.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Ahmed Abdalrazak Rasheed Al Dulaimy, Ghayath Abd Ali Shalal Al Dulaimy, Sadiq Mahdi Hussein Al Dulaimy
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Permit others to copy and distribute the manuscript; to extract, revise, and create another derivative
works of or from the manuscript (e.g., a translation); to incorporate the manuscript into a
collective work; and to text or data mine the article, even for commercial purposes, provided that
the author(s) is/are credited; the article's modifications should not harm the author's honor or
reputation; and the article should not be altered in a way that would cause the author to lose them
reputation. The Creative Commons Attribution 4.0 International License (CC BY 4.0) has more
information.