Immunological biomarkers in neuropsychiatric systemic lupus erythematosus: a comparative cross-sectional study from a tertiary care center in South India

Abstract

Introduction The prevalence of various immunological biomarkers in neuropsychiatric systemic lupus erythematosus (NPSLE) differs among various patients with varied neuropsychiatric manifestations and different populations. We studied the prevalence of these biomarkers; especially the neuron specific autoantibodies in patients with systemic lupus erythematosus (SLE) and compared them among patients with and without neuropsychiatric involvement. Methodology This is a comparative cross-sectional study conducted in a tertiary care hospital in South India. The prevalence of immunological biomarkers including complement levels, systemic and brain specific autoantibodies (anti-myelin antibody, anti–myelin oligodendrocyte glycoprotein and anti–myelin-associated glycoprotein antibody) were assessed and compared among those with and without NPSLE and with different NPSLE manifestations. Results A total of 522 SLE patients were enrolled in the study. The mean age of the study participants was 28.5 ± 8.8 years and 93.5% were women. Neuropsychiatric manifestations were seen in 167 (32%) patients. Seizure was the most common neuropsychiatric manifestation seen in 41.3%, followed by psychosis (18.6%), mood disorder (16.8%), stroke (10.8%), mononeuropathy (10.2%), headache (9.6%), acute confusional state (6.6%) and aseptic meningitis (5.4%). Patients with NPSLE had a higher SLE disease activity index score. Most of the autoantibodies, that is anticardiolipin antibody (aCL), anti–β2 glycoprotein 1 antibody (β2GP1), lupus anticoagulant (LA), anti-nucleosome, anti–ribosomal P, anti-Ro52, anti-Ro60 and anti-La, were seen in higher proportion in the NPSLE group, although the difference failed to reach statistical significance. On subgroup analysis, psychosis was significantly higher in patients with anti-ribosomal P positivity than without (11.8% versus 4.1%, p.0.007; odds ratio (OR) 3.1, confidence interval (CI) 1.4–6.8), while stroke had a higher proportion among those with positive b2GP1 IgG (6.3% versus 1.8%, p.0.03; OR 3.6, CI 1.2–11.0). A higher proportion of demyelination was seen among the LA positive than the negative (10.3% versus 0.2%, p.0.03; OR 5.39, CI 1.15–24.17) and anti–myelin oligodendrocyte glycoprotein in mood disorder (14.3% versus 3.4%, p = 0.03; OR 4.66, CI 1.13–19.13). Conclusion No single biomarker correlated with NPSLE. Among different NPSLE manifestations, the prevalence of IgG β2GP1 in stroke, LA in demyelination, anti–ribosomal P in psychosis and anti–myelin oligodendrocyte glycoprotein in mood disorder were higher. Further studies on the pathogenic mechanisms underlying NPSLE and its different manifestations may help us to identify better biomarkers.

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

“…In a study by Hanly et al, NP events attributed to lupus most frequently occurred around diagnosis and patients without NP events at initial assessment had a 74% probability of being event free at 10 years of follow-up. 12 Similar observations were made in a series from South India where the median duration from onset of disease to onset of first NPSLE syndrome was 4 months 13 Hence, the risk of NPSLE events is maximum around diagnosis. NPSLE patients had a higher SLEDAI 2k scores as compared to controls in our series.…”

“…13 As compared to 3 other series reported from India, we found a higher prevalence of cerebrovascular accidents. [13][14][15] CNS involvement was the most common followed by PNS and psychiatric. We found a higher prevalence of mononeuropathy compared to polyneuropathy as previously reported in most studies.…”

“…12 The most common NP manifestation in our study was seizures which was similar to a study of 522 lupus patients from South India. 13 As compared to 3 other series reported from India, we found a higher prevalence of cerebrovascular accidents. [13][14][15] CNS involvement was the most common followed by PNS and psychiatric.…”

“…Autoantibodies are not reliable biomarkers to predict NPSLE. 20 Although certain autoantibodies are associated with NPSLE syndromes 13 they are neither sensitive nor specific to guide diagnosis and monitoring in routine practice.…”

Autoimmune diseases and cancers overlapping with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): A systematic review

“… 68 , 75 Given the overall rarity of double positive cases based on the results of the larger studies, and considering the superior specificity of the AQP4-IgG test compared to the MOG-IgG test, and that a reliable cell-based-assay (CBA) for detecting MOG-IgG has been available just recently (2017), there is a high possibility that most of the double positive cases may likely be AQP4-IgG + NMOSD with false positive MOG-IgG test results, especially in reports made before this time with using enzyme-linked immunosorbent assay (ELISA). 68 , 75 …”