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

Abstract

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.

Transverse myelitis associated with systemic lupus erythematosus (SLE-TM): A review article

“…13,14 This is most likely due to better diagnostic Similar to SLE, SLE-TM occurs predominantly in females. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] A recent literature review by Wen et al 10 estimated the mean age at diagnosis as 36.89 years (range 12-77). Although NPSLE is more prevalent in African and Asian populations, 3 no good data exists regarding SLE-TM.…”

“…The authors thus postulated that circulating aPL are unlikely to have a pathogenic or prognostic role in SLE-TM and are not reliable to dictate anticoagulation or antiplatelet use. Subsequent studies have relayed mixed messages; [8][9][10][11][12]14,15 however, due to the nature of these studies and small numbers, further research is needed to help to clarify this better.…”

“…As mentioned previously, patients may be divided into LETM or SSTM based on MRI findings; however, clinical findings may not always mirror imaging findings. 8,20 Along with MRI spine, all patients should also have a contrast enhanced MRI brain. This helps to rule out demyelinating conditions causing myelitis, especially MS and NMOSD.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20][21] Most recovery occurs within the first 3 months, however, can continue for even ≥1 year. 8 A small proportion of patients unfortunately have no improvement resulting in significant disability. Death is uncommon and usually occurs due to other causes, most commonly infections, rather than SLE-TM itself.…”

“…26 They can cause focal or diffuse inflammation leading to neurological symptoms.(c) Anti-Ro/SSA antibodies – are thought to be risk factors for developing SLE-TM, although the mechanism remains unclear. 8 …”