Clinical value of autoantibodies for lupus myelitis and its subtypes: A systematic review

Oiwa, Hiroshi; Kuriyama, Akira; Matsubara, Tomoyasu; Sugiyama, Eiji

doi:10.1016/j.semarthrit.2018.02.004

Cited by 7 publications

(8 citation statements)

References 82 publications

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“…These results provide clues regarding the mechanisms underlying the function of TM-related nerve injury which could inform treatment. However, it is important to note that we did not identify a strong correlation between anti-dsDNA or hypocomplementemia and the prognosis of TM, which is consistent with previously reported ndings [4,6,23]. Differences in the sample populations across studies may contribute to noted differences.…”

Section: Discussionsupporting

confidence: 86%

“…The presence of antiphospholipid antibodies should always be considered as a possible aetiology for SLE-related TM through their thromboembolic effects on the microcirculation of the spine [22]. However, the diagnostic value of aPL remains controversial [5,7,23].In our review of the literature, we found that although the presence or absence of aPL has been examined in the diagnosis of SLE-related TM, the individual subtypes of aPL (LA, ACL, and anti-β2GPI) have not been considered. In our study, aPL and its subtypes were not predictive of short-term TM prognosis.…”

Section: Discussionmentioning

confidence: 99%

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Identification of Risk and Prognostic Factors for Transverse Myelitis in Systemic Lupus Erythematosus

Wang

Zhang

et al. 2021

Preprint

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Purpose: Our aim in this study was to describe the clinical characteristics and outcomes of patients with transverse myelitis (TM) as a rare phenotype of systemic lupus erythematosus (SLE) and to identify the risk and prognostic factors for SLE-related TM.Methods: The analysis was based on 58 patients with SLE-related TM admitted to Peking Union Medical College Hospital between January 1993 and May 2021.The control group included 101 patients, randomly selected from our SLE patient group, without TM, using propensity score matching for age at SLE diagnosis, sex, and SLE disease course. Conditional logistic regression and Cox proportional hazard regression were used to identify risk and prognostic factors for SLE-related TM. Results: Multivariate analysis revealed that anti-SSA(p<0.001) and anti-RNP positivity (p=0.005) were independent risk factors for SLE-related TM. With regard to prognosis, an American Spinal Injury Association Impairment Scale (AIS) grade of A or B at the early stage of TM (p<0.001) and hypoglycorrhachia (p=0.016) were independent risk factors for unfavourable neurological outcomes. In regard to neurological recovery at 3 months, an American Spinal Injury Association Impairment Scale (AIS) grade of A, B, or C at the early stage of TM was the only prognostic factor for SLE-related TM (hazard ratio, 0.26; 95% confidence interval, 0.08-0.91; p=0.035). Conclusions: Anti-SSA and anti-RNP positivity were independent risk factors for TM in patients with SLE. Initial severe myelitis and hypolycorrhachia are predictive of a poor prognosis. Glucocorticoid pulse therapy provided within 2 weeks of TM onset may improve TM prognosis. Understanding the risk and prognostic factors of TM is important as permanent neurological disability persists in a significant proportion of patients with SLE-related TM.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Identification of Risk and Prognostic Factors for Transverse Myelitis in Systemic Lupus Erythematosus

Wang

Zhang

et al. 2021

Preprint

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“… 6 , 8 - 10 The timing of imaging (either too early or too late in the disease course) and lesser sensitivity of conventional spinal MRI have been long considered responsible for missing the subtle signal changes (intra- or extra-axial) in these cases by many researchers. 3 , 6 , 9 , 10 Nevertheless, this patient was subjected to multiple follow-up neuroimaging of standard sensitivity; henceforth, we suggest a functional disruption in the spinal tracts without any demonstrable structural damage.…”

Section: Discussionmentioning

confidence: 88%

Magnetic resonance imaging-negative myeloneuropathy and bilateral facial paresis unfurling systemic lupus erythematosus

Ghosh

Das

Dubey

et al. 2022

Qatar Medical Journal

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Systemic lupus erythematosus is a chronic autoimmune connective tissue disorder that can affect all the neuroaxes in the central and peripheral nervous systems. Myelopathy in systemic lupus erythematosus is one of the least common neuropsychiatric syndromes accounting for 1%–2% of cases. Myelopathy has long been diagnosed based on clinical findings, laboratory tests, and gold-standard gadolinium-enhanced magnetic resonance imaging (MRI). MRI-negative myelopathy is a recently described subset of myelopathies. Here, we report the case of a young woman from rural West Bengal, India, who presented with overlapping features of white-matter and gray-matter myelopathy associated with peripheral neuropathy and bilateral asymmetric lower motor neuron-type facial paresis. The historical analysis yielded clues toward an etiological diagnosis of systemic lupus erythematosus, further substantiated by seropositivity of lupus-specific autoantibodies. Her neurological disabilities responded poorly to oral administration of hydroxychloroquine, bolus intravenous administration of methylprednisolone, and high-dose cyclophosphamide therapy but eventually responded remarkably well to cyclical rituximab therapy. This case adds to the tally of cases of MRI-negative lupus myelopathy. MRI-negative myelopathy in systemic lupus erythematosus can be easily missed if not meticulous attention is paid during clinical history taking and examinations.

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“… 24 However, the clinical value of aPL in SLE-TM remains controversial. 5 , 7 , 25 In our review of the literature, although the presence or absence of aPL was examined in the development of SLE-TM, the individual profiles of aPL (LA, aCL, and anti-β2GPI) have not been considered. Nevertheless, we found that aPL and different aPL profiles results were not predictive of the presence of the TM and short-term TM prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, we did not identify a strong correlation between anti-dsDNA, hypocomplementemia, or SLEDAI scores and TM prognosis, which were reported in previous studies. 4 , 6 , 25 Differences in the sample populations across studies may have contributed to the noted contradiction.…”

Section: Discussionmentioning

confidence: 99%

Exploring the risk factors and prognosis of transverse myelitis in systemic lupus erythematosus

Wang

Zhang

et al. 2022

Therapeutic Advances in Chronic Disease

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Purpose: We aimed to describe the clinical characteristics and outcomes of patients with transverse myelitis (TM) as a rare manifestation in systemic lupus erythematosus (SLE) and explore the risk factors and prognosis of SLE-related TM (SLE-TM). Methods: We conducted a retrospective case–control and cohort analysis. All patients with SLE-TM (58 patients) and 232 with SLE without TM, as a control group, were admitted to Peking Union Medical College Hospital between January 1993 and May 2021. Factors associated with the presence of SLE-TM and its prognosis were assessed using logistic regression and Cox proportional hazard models. Results: Multivariate analysis revealed that positive anti-Ro/Sjogren’s syndrome A (anti-Ro/ SSA) (<0.01) and increased erythrocyte sedimentation rate (ESR) ( p < 0.01) were associated with SLE-TM. Regarding prognosis, methylprednisolone (MP) pulse therapy within 2 weeks of onset (adjusted hazard ratio (AHR), 2.12; 95% confidence interval (CI), 1.06–4.23; p = 0.03) was associated with short-term neurological improvement. An American Spinal Injury Association Impairment Scale (AIS) grades of A, B, or C at onset (AHR, 0.12; 95% CI 0.05–0.28; p < 0.001) and hypoglycorrhachia (AHR, 0.29; 95% CI, 0.13–0.65; p < 0.01) were associated with a short-term non-improved outcome. Conclusions: The positive anti-Ro/SSA antibodies and increased ESR may be associated with the presence of SLE-TM. An initial presentation with severe myelitis and hypoglycorrhachia appear to be predictors of a poor neurological outcome. Early steroid pulse therapy may improve the prognosis.

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Clinical value of autoantibodies for lupus myelitis and its subtypes: A systematic review

Cited by 7 publications

References 82 publications

Identification of Risk and Prognostic Factors for Transverse Myelitis in Systemic Lupus Erythematosus

Identification of Risk and Prognostic Factors for Transverse Myelitis in Systemic Lupus Erythematosus

Magnetic resonance imaging-negative myeloneuropathy and bilateral facial paresis unfurling systemic lupus erythematosus

Exploring the risk factors and prognosis of transverse myelitis in systemic lupus erythematosus

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