Cerebral Blood Flow in Depressed Patients with Systemic Lupus Erythematosus

Giovacchini, Giampiero; Mosca, Marta; Manca, Gianpiero; Porta, Mauro; Neri, Claudia; Bombardieri, Stefano; Ciarmiello, Andrea; Strauß, Harald; Mariani, Giuliano; Volterrani, Duccio

doi:10.3899/jrheum.100121

Cited by 18 publications

(13 citation statements)

References 45 publications

(67 reference statements)

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“…1,34 Taken together, these findings offer preliminary evidence that haemodynamic disturbances in NPSLE may be partly responsible for heightened emotional difficulties in this group of patients, rather than being secondary to the physical and social burden incurred by a severe chronic disease such as SLE. In addition, our results extend an earlier report of reduced prefrontal CBF in SLE patients displaying clinician-rated depressive disorder 35 by demonstrating that reduced relative blood flow is directly linked to anxiety, rather than the often comorbid depressive symptomatology.…”

Section: Discussionsupporting

confidence: 85%

Regional cerebral perfusion correlates with anxiety in neuropsychiatric SLE: evidence for a mechanism distinct from depression

Papadaki

Kavroulakis

Βertsias

et al. 2019

Lupus

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The study examined the hypothesis that hypoperfusion in brain areas known to be involved in emotional disturbances in primary psychiatric disorders is also linked to emotional difficulties in systemic lupus erythematosus (SLE) and that these are not secondary to the physical and social burden incurred by the disease. Nineteen SLE patients without overt neuropsychiatric manifestations (non-NPSLE), 31 NPSLE patients, and 23 healthy controls were examined. Dynamic susceptibility contrast MRI was used and cerebral blood flow and cerebral blood volume values were estimated in six manually selected regions of interest of brain regions suspected to play a role in anxiety and depression (dorsolateral prefrontal cortex, ventromedial prefrontal cortex, anterior cingulate cortex, hippocampi, caudate nuclei and putamen). NPSLE patients reported high rates of anxiety and depression symptomatology. Significantly reduced cerebral blood flow and cerebral blood volume values were detected in the NPSLE group compared to healthy controls in the dorsolateral prefrontal cortex and ventromedial prefrontal cortex, bilaterally. Within the NPSLE group, anxiety symptomatology was significantly associated with lower perfusion in frontostriatal regions and in the right anterior cingulate gyrus. Importantly, the latter associations appeared to be specific to anxiety symptoms, as they persisted after controlling for depression symptomatology and independent of the presence of visible lesions on conventional MRI. In conclusion, hypoperfusion in specific limbic and frontostriatal regions is associated with more severe anxiety symptoms in the context of widespread haemodynamic disturbances in NPSLE.

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Section: Discussionsupporting

confidence: 85%

Regional cerebral perfusion correlates with anxiety in neuropsychiatric SLE: evidence for a mechanism distinct from depression

Papadaki

Kavroulakis

Βertsias

et al. 2019

Lupus

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“…Among the literature initially identified, 13 studies met the inclusion criteria. 6,11,13,[22][23][24][25]27,32,[37][38][39][40] Sample sizes ranged from 20 to 349 subjects; all studies involved male and female adult subjects. The results of the available literature are again contradictory.…”

Section: Depression and Sle: Psychobiological Hypothesesmentioning

confidence: 99%

Depression and systemic lupus erythematosus: a systematic review

Palagini

Mosca

Tani

et al. 2013

Lupus

161

136

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Differences in assessment techniques appear to be the main explanation for the variability in findings and important methodological limitations are present in the available literature to definitively point to the prevalence of depression, type of depression and most prevalent symptoms. To date, the relationship between depression and SLE disease activity also appears controversial. Methodological limitations are present in the available literature and it would be necessary to develop evidence-based guidelines to improve the diagnosis of depression in SLE. Identification of SLE-specific biomarkers of depression also has high priority.

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“…Although psychological effects of dealing with a chronic disease may contribute to the high prevalence of depression, disease-specific mechanisms probably play a role. Associations with specific antibodies and alterations in cerebral blood flow have been reported in depressed SLE patients [84,85]. However, the data are not conclusive and depression in patients with SLE should be treated with conventional measures similar to the general population.…”

Section: Quality Of Life In Systemic Lupus Erythematosusmentioning

confidence: 99%

Unmet medical needs in systemic lupus erythematosus

2012

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Systemic lupus erythematosus (SLE) is an autoimmune disease of diverse manifestations, with onset usually in young women in the third to fourth decade of life. The chronic nature of this relapsing remitting disease leads to organ damage accrual over time. Mortality and morbidity are increased in patients with SLE compared with the general population. Therapeutic advances over the last few decades have led to significant improvements in patient outcomes. Five-year survival has improved to over 90% from a low of 50% in the 1950s. However, multiple aspects of the management of SLE patients are still far from optimal. Early diagnosis remains a challenge; diagnostic delays leading to delay in definitive treatment are common. Monitoring treatment remains problematic due to the paucity of sensitive biomarkers. Current treatment regimens rely heavily on corticosteroids, even though corticosteroids are well known to cause organ damage. Treatment of refractory disease manifestations such as nephritis, recalcitrant cutaneous lesions and neurological involvement require new approaches with greater efficacy. Cognitive dysfunction is common in SLE patients, but early recognition and adequate treatment are yet to be established. Premature accelerated atherosclerosis remains a leading cause of morbidity and mortality. Fatigue is one of the most disabling symptoms, and contributes to the poor quality of life in patients with SLE. Ongoing research in SLE faces many challenges, including enrollment of homogeneous patient populations, use of reliable outcome measures and a standard control arm. The current review will highlight some of the outstanding unmet challenges in the management of this complex disease.

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Cerebral Blood Flow in Depressed Patients with Systemic Lupus Erythematosus

Abstract: Depressed patients with SLE have CBF reductions in discrete temporal and frontal regions that may account for depressive symptoms.

Cited by 18 publications

References 45 publications

Regional cerebral perfusion correlates with anxiety in neuropsychiatric SLE: evidence for a mechanism distinct from depression

Regional cerebral perfusion correlates with anxiety in neuropsychiatric SLE: evidence for a mechanism distinct from depression

Depression and systemic lupus erythematosus: a systematic review

Unmet medical needs in systemic lupus erythematosus

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