Value of multidisciplinary reassessment in attribution of neuropsychiatric events to systemic lupus erythematosus: prospective data from the Leiden NPSLE cohort

Magro-Checa, César; Zirkzee, E.; Voorde, Liesbeth J J Beaart-van de; Middelkoop, Huub A. M.; Wee, Nic J. van der; Huisman, Menno V.; Eikenboom, Jeroen; Kruyt, Nyika D.; Buchem, Mark A. van; Huizinga, Tom W J; Steup-Beekman, Gerda M

doi:10.1093/rheumatology/kex019

Cited by 50 publications

(54 citation statements)

References 19 publications

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“…Attribution of neuropsychiatric manifestations to SLE often requires a comprehensive, multidisciplinary approach to rule out mimics (infections, malignancy and others), taking into account the presence of risk (‘ favouring ’ ) factors (type and timing of manifestation, presence of generalised, non-neurological disease activity, abnormal neuroimaging and cerebrospinal fluid analysis, positive antiphospholipid antibodies [aPL]),97 as well as confounding factors favouring alternative diagnoses 98. The use of validated attribution models may aid in the diagnostic process 99 100…”

Section: Resultsmentioning

confidence: 99%

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

et al. 2019

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Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007–12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion.

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Section: Resultsmentioning

confidence: 99%

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

et al. 2019

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“…Depending on the model adopted, 19-38% of the NP events were attributed to NPSLE. In an independent prospective validation study, model A demonstrated an excellent specificity of 98% and poor sensitivity of 33%, while model B demonstrated a satisfactory specificity of 86% and fair sensitivity of 64% [16]. The intermodel discrepancy revealed the impact of altering the stringency of the decision rules.…”

Section: Clinical Significancementioning

confidence: 97%

Management of Psychosis in Neuropsychiatric Lupus

Kang

Mok

2019

Journal of Clinical Rheumatology and Immunology

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Manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE) are heterogeneous. Acute psychosis is an uncommon but well-recognized manifestation of NPSLE. With no specific biomarkers to date, the diagnosis of NPSLE relies on clinical acumen for circumstantial evidence and exclusion of important differential diagnoses. The attribution of psychosis to NPSLE is facilitated by the application attribution models. In particular, the American College of Rheumatology nomenclature, Systemic Lupus International Collaborating Clinics attribution models and Italian algorithm for the attribution of psychosis to NPSLE are revisited. The mainstay of treatment for psychosis attributable to NPSLE is immunosuppression and symptomatic control. In refractory cases, immunomodulatory and emerging biological agents may be considered. This article reviews the diagnostic dilemma, pathogenic mechanisms and treatment of psychosis in SLE patients.

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“…However, these models have been developed with the expert opinion being the diagnostic gold standard, with no objective corroborating evidence. Therefore, the attribution of CD to SLE remains mainly reliant on the clinician's assessment, index of suspicion and clinical reasoning, which can benefit from the introduction of a collaborative multidisciplinary approach including neuropsychological, radiological and laboratory evaluations [21,39].…”

Section: Attribution Of CD To Slementioning

confidence: 99%

Cognitive dysfunction in autoimmune rheumatic diseases

Oláh¹,

Schwartz

Denton

et al. 2020

Arthritis Res Ther

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For people with chronic autoimmune rheumatic diseases (AIRD), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or systemic sclerosis (SSc), normal cognitive functions are essential for performing daily activities. These diseases may be associated with cognitive dysfunction (CD). In RA, CD has been associated with age, lower education and disease duration and activity. Great advances have been achieved in neuropsychiatric SLE in the identification of pathogenic pathways, assessment and possible treatment strategies. SSc rarely exerts direct effects on the brain and cognitive function. However, the psychological burden that includes depression, anxiety and social impact may be high. AIRD patients with sustained disease activity, organ damage or lower education should be evaluated for CD. The control of systemic inflammation together with tailored behavioural cognitive therapies may benefit these patients.

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Value of multidisciplinary reassessment in attribution of neuropsychiatric events to systemic lupus erythematosus: prospective data from the Leiden NPSLE cohort

Cited by 50 publications

References 19 publications

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Management of Psychosis in Neuropsychiatric Lupus

Cognitive dysfunction in autoimmune rheumatic diseases

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