Clinical, neuroimaging and immunological phenotype of South African neuropsychiatric systemic lupus erythematosus patients

Abstract

Neuropsychiatric systemic lupus erythematosus (NPSLE) is an important cause of morbidity and mortality. We undertook this observational retrospective study of patients with NPSLE who had brain magnetic resonance imaging (MRI) to determine the indications for MRI and the correlation of clinical and laboratory findings with MRI. We identified 83 NPSLE patients (84.3% women) seen at Inkosi Albert Luthuli Central Hospital in Durban, South Africa, between June 2003 and May 2017. The mean age at SLE diagnosis was 26.24 ± 12.81 years and the median interval to NPSLE was 11.0 (interquartile range, 4.0–39.0) months. The most common indications for MRI were seizures (45.8%), psychosis (18.1%) and cerebrovascular disease (18.1%). The MRI was abnormal in 68 (81.9%) with small-vessel disease in 65 (78.3%) and large-vessel disease in eight (9.6%). The small-vessel abnormalities were white-matter hyperintensities (WMH) (59.0%), atrophy (55.4%) and lacunae (4.6%). Our patients had high disease activity at NPSLE. Cerebrovascular disease was associated with an abnormal MRI ( p = 0.018) and large-vessel disease ( p = 0.014) on MRI. Our NPSLE patients were younger and had high disease activity, and seizures were more common compared with other studies. The most common MRI abnormalities were WMH and cortical atrophy, in agreement with other studies.

Neuropsychiatric manifestations and their attribution to SLE: a retrospective single-center study in the Polish population

“…Similar to our study (as well as in the studies by other authors [30,31]), the disease activity in Chinese patients with SLE was higher in the NPSLE group than those without NP symptoms (SLEDAI-2K: 25.3(8.8) vs 8.6(6.7)) [29]. Seizures were also the most common (45.8%) NP syndrome in the NPSLE cohort from South Africa, followed by psychosis (18.1%) and cerebrovascular disease (18.1%) [32].…”

Neuropsychiatric manifestations are associated with increased mortality in Indian patients with lupus: A single centre retrospective observational study

“…24 Small vessel disease is more common than large vessel disease in patients with neuropsychiatric lupus as documented by most MRI brain series. 24,26 Cyclophosphamide was used for induction in half of our patients with NPSLE. One controlled trial comparing methylprednisolone pulses with intravenous cyclophosphamide for severe NPSLE found it to be efficacious in 75% of the patients.…”

“…24 Small vessel disease is more common than large vessel disease in patients with neuropsychiatric lupus as documented by most MRI brain series. 24,26…”