Controversies in lupus: nervous system involvement.

Bruyn, G. A. W.

doi:10.1136/ard.54.3.159

Cited by 76 publications

(70 citation statements)

References 74 publications

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“…Furthermore, the concept of hypercoagulability in SLE patients has diverted the direction of therapy from immunosuppression [30] (as in the majority of our patients) towards anticoagulation [31]. Randomized trials have commenced in order to determine the optimal mode of therapy for SLE patients under strict inclusion criteria, based on well-defined patient categories.…”

Section: Discussionmentioning

confidence: 99%

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

et al. 1997

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Abstract. In contrast to morphological imaging [such as magnetic resonance imaging (MRI) or computed tomography], functional imaging may be of advantage in the detection of brain abnormalities in cases of neuropsyehiatric systemic lupus erythematosus (SLE). Therefore, we studied 13 patients (aged 40_+14 years, 11 female, 2 male) with neuropsychiatric SLE who met four of the American Rheumatism Association criteria for the classification of SLE. Ten clinically and neurologically healthy volunteers served as controls (aged 40+12 years, 5 female, 5 male). Both groups were investigated using fluorine-18-1abelled fluorodeoxyglucose brain positron emission tomography (PET) and cranial MRI. The normal controls and 11 of the 13 patients showed normal MRI scans. However, PET scan was abnormal in all 13 SLE patients. Significant group-to-group differences in the glucose metabolic index (GMI=region of interest uptake/global uptake at the level of the basal ganglia and thalamus) were found in the parieto-occipital region on both sides: the GMI of the parieto-oceipital region on the right side was 0.922+0.045 in patients and 1.066+0.081 in controls (P<0.0001, Mann Whitney U test), while on the left side it was 0.892+0.060 in patients and 1.034+0.051 in controls (P=0.0002). Parietooccipital hypometabolism is a conspicuous finding in mainly MRl-negative neuropsychiatric SLE. As the parieto-occipital region is located at the boundary of blood supply of all three major arteries, it could be the most vulnerable zone of the cerebrum and may be affected at an early stage of the cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

et al. 1997

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“…With regard to the pathogenesis of the nervous damage in connective tissue diseases, several hypothetical mechanisms have been proposed, such as vasculitis involving vasa nervorum, secondary amyloidosis and immunological factors [3,5], including circulating autoantibodies to myelin-associated components [10,11]. However, the clinical relevance of the autoantibodies has not been established.…”

Section: Introductionmentioning

confidence: 99%

Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures

Maule¹,

Quadri²,

Mirante³

et al. 1997

Clinical and Experimental Immunology

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SUMMARYAutonomic nervous dysfunction has been previously reported in SLE, RA and systemic sclerosis, but the pathogenesis of such a complication is poorly understood. In the present study, four standard cardiovascular autonomic function tests were performed in 34 female patients with connective tissue diseases and in 25 healthy control subjects, and results expressed as cardiovascular (CV) test scores. Moreover, in each subject the presence of circulating complement-fixing autoantibodies directed against sympathetic and parasympathetic nervous structures, represented by superior cervical ganglia and vagus nerve, respectively, was simultaneously assessed by an indirect immunofluorescent complement-fixation technique, using rabbit tissue as substrate. None of the patients reported autonomic symptoms. However, an abnormal CV test score (Ն 5) was detected in 15% of the patients and in none of the healthy control subjects, approaching statistical significance (P ¼ 0·07). No correlation was found between CV test results and disease duration, type of therapy or presence of conventional autoantibodies. One or two autoantibodies to autonomic nervous structures were detected in six patients (18%) and not in the control subjects (P < 0·05). Values of deep breathing test were significantly lower in autoantibody-positive patients compared with those amongst the control subjects (P < 0·05), and an abnormal CV test score was significantly associated with the presence of autoantibodies to autonomic nervous structures (P < 0·05). In conclusion, we confirm that autonomic nervous function can be impaired in patients with connective tissue diseases, and suggest that autoantibodies directed against autonomic nervous system structures may play a role in the pathogenesis of the autonomic dysfunction.

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“…Although seizures and psychosis were included among the American Rheumatism Association criteria for the diagnosis of SLE, causes of central nervous system (CNS) dysfunction have been a matter of controversy for many years (Bruyn 1995). Nevertheless, contemporary imaging studies corroborate the notion that neuropsychiatric lupus (NP-SLE) is an autoimmunity-induced brain disorder, characterized by impaired blood flow, metabolic alterations, and progressive neuronal loss (Griffey et al 1990;Sibbitt and Sibbitt 1993;Sibbitt et al 1989Sibbitt et al , 1994Brooks et al 1997).…”

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confidence: 99%

Behavioral heterogeneity in an animal model of neuropsychiatric lupus

Šakić¹,

Hanna²,

Millward³

2005

Biological Psychiatry

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Background-Various psychiatric manifestations of unknown etiology are common in systemic autoimmune disease lupus erythematosus (SLE). Profound heterogeneity at clinical and neuropathological levels suggests distinct subpopulations of SLE patients and multiple mechanisms in the pathogenesis of aberrant behavior. Using inbred mice prone to SLE-like condition, we presently examine whether subpopulations of diseased mice can be identified on the basis of their behavioral performance.

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Controversies in lupus: nervous system involvement.

Cited by 76 publications

References 74 publications

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures

Behavioral heterogeneity in an animal model of neuropsychiatric lupus

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