Impact Analysis of Autoantibody Level and NR2 Antibody Level in Neuropsychiatric SLE Treated by Methylprednisolone Combined with MTX and DXM Intrathecal Injection

Wang, Jingyuan; Zhao, Yi‐Fang; Zhang, Jihui; Lei, Hongwei; Zhu, Gui‐Qi; Fu, Bingbing

doi:10.1007/s12013-014-0010-9

Cited by 14 publications

(6 citation statements)

References 25 publications

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“…Recent studies commonly report that a subset of anti-dsDNA antibodies might cross-react with the N-methyl-D-aspartate receptor, induce apoptosis of hippocampal neurons, and are associated with CNS NPSLE, including cognitive disorder. 38–41 However, our analysis findings oppose these trends; lower serum dsDNA positivity in NPSLE patients has been reported in previous studies. 10,21 In particular, comparing the serum and cerebrospinal fluid (CSF) anti-dsDNA antibody levels of NPSLE and non-NPSLE patients, the CSF dsDNA antibody level was higher in NPSLE patients, but the serum dsDNA antibody level was lower in non-NPSLE patients.…”

Section: Discussioncontrasting

confidence: 84%

Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: a prospective, single-center study

Ahn

Kim

Won³

et al. 2018

Lupus

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Objective The objective of this paper is to identify the prevalence, risk factors, and impact on mortality of neuropsychiatric systemic lupus erythematosus (NPSLE). Methods Patients from the Hanyang BAE lupus cohort were registered and followed from 1998 to 2015. NPSLE was defined using American College of Rheumatology (ACR) case definitions and Ainiala criteria. Demographics, autoantibodies, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and Systemic Lupus International Collaborating Clinic (SLICC)/ACR Damage Index were collected at baseline and then annually. Mortality data were derived by linking data from the Korean National Statistics Office. Multivariable logistic regression and Cox regression analysis were conducted in the inception cohort to assess the risk factors and mortality impact of NPSLE. Results Of 1121 registered patients, 429 (38.3%) had NPSLE manifestations according to ACR criteria and 216 (19.3%) by Ainiala criteria. In multivariable logistic regression analysis, higher SLEDAI (OR 1.08, CI 1.01-1.16, p = 0.02) and antiphospholipid antibody positivity (OR 1.72, CI 1.03-2.87, p = 0.04) at SLE diagnosis increased NPSLE risk, while elevated anti-dsDNA antibodies (OR 0.43, CI 0.24-0.78, p < 0.01) and greater education duration (OR 0.92, CI 0.85-1.00, p = 0.04) showed reduced risk of NPSLE. Cox proportional hazard models demonstrated that presence of NPSLE had a three-fold increased risk of mortality (HR 3.09, CI 1.03-9.21, p = 0.04), especially in patients with focal CNS NPSLE (HR = 7.83, CI 2.12-28.96, p < 0.01). Conclusion Higher SLEDAI, antiphospholipid antibody positivity, absence of anti-dsDNA antibody at SLE diagnosis, and fewer years of education are risk factors for development of NPSLE. Presence of NPSLE, especially focal CNS NPSLE, increased the risk of mortality in SLE patients.

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Section: Discussioncontrasting

confidence: 84%

Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: a prospective, single-center study

Ahn

Kim

Won³

et al. 2018

Lupus

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“…A total of 109 patients received a combination of intrathecal methotrexate and dexamethasone (one to five injections), and showed an association with a positive outcome [ 122 ]. Wang et al reported an effectiveness rate of 89 % of methylprednisolone treatment combined with intrathecal methotrexate in 36 NPSLE patients [ 123 ]. In addition to these results, intrathecal administration of methotrexate is not considered common practice and is limited to a few centers [ 38 ].…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Management of Neuropsychiatric Systemic Lupus Erythematosus: Current Approaches and Future Perspectives

Magro-Checa

Zirkzee

Huizinga

et al. 2016

Drugs

175

176

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Neuropsychiatric systemic lupus erythematosus (NPSLE) is a generic definition referring to a series of neurological and psychiatric symptoms directly related to systemic lupus erythematosus (SLE). NPSLE includes heterogeneous and rare neuropsychiatric (NP) manifestations involving both the central and peripheral nervous system. Due to the lack of a gold standard, the attribution of NP symptoms to SLE represents a clinical challenge that obligates the strict exclusion of any other potential cause. In the acute setting, management of these patients does not differ from other non-SLE subjects presenting with the same NP manifestation. Afterwards, an individualized therapeutic strategy, depending on the presenting manifestation and severity of symptoms, must be started. Clinical trials in NPSLE are scarce and most of the data are extracted from case series and case reports. High-dose glucocorticoids and intravenous cyclophosphamide remain the cornerstone for patients with severe symptoms that are thought to reflect inflammation or an underlying autoimmune process. Rituximab, intravenous immunoglobulins, or plasmapheresis may be used if response is not achieved. When patients present with mild to moderate NP manifestations, or when maintenance therapy is warranted, azathioprine and mycophenolate may be considered. When symptoms are thought to reflect a thrombotic underlying process, anticoagulation and antiplatelet agents are the mainstay of therapy, especially if antiphospholipid antibodies or antiphospholipid syndrome are present. Recent trials on SLE using new biologicals, based on newly understood SLE mechanisms, have shown promising results. Based on what we currently know about its pathogenesis, it is tempting to speculate how these new therapies may affect the management of NPSLE patients. This article provides a comprehensive and critical review of the literature on the epidemiology, pathophysiology, diagnosis, and management of NPSLE. We describe the most common pharmacological treatments used in NPSLE, based on both a literature search and our expert opinion. The extent to which new drugs in the advanced development of SLE, or the blockade of new targets, may impact future treatment of NPSLE will also be discussed.

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“…Despite the relatively large number of patients in this study, there was no follow-up information, and thus, the long-term influence of intrathecal treatment on NPSLE was unknown. Another small-size study included 36 NPSLE patients treated with MTX and DEX intrathecally and 36 SLE patients without neuropsychiatric symptoms as the control group, where all patients had steroid pulse treatment[ 11 ]. After treatment, 77.8% (28/36) of the NPSLE cases were in clinical remission, 11.1% (4/36) of the cases were effectively treated, and 11.1% (4/36) of the cases were invalid, with a total effective rate of 88.9%.…”

Section: Introductionmentioning

confidence: 99%

The influence of intrathecal injection of methotrexate and dexamethasone on neuropsychiatric systemic lupus erythematosus (NPSLE): a retrospective cohort study of 386 patients with NPSLE

Nie

Sun

et al. 2023

Arthritis Res Ther

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Background Neuropsychiatric involvement is one of the major concerns in systemic lupus erythematosus (SLE). The therapeutic effect of intrathecal treatment of methotrexate and dexamethasone has been investigated in some exploratory studies, but its influence on the long-term prognosis of neuropsychiatric SLE (NPSLE) remains unknown. Methods This was a propensity score-matched retrospective study. Outcomes at discharge and time free from NPSLE relapse or death were evaluated by multivariate logistic regression, survival analysis, and Cox regression as appropriate. Results Among 386 hospitalized patients with NPSLE, the median [IQR] age was 30.0 [23.0–40.0] years, and 342 patients (88.4%) were female. Of those, 194 patients received intrathecal treatment. Patients in the intrathecal treatment group had higher Systemic Lupus Erythematosus Disease Activity Index 2000 scores (median 17 vs. 14 points, IQR 12–22 vs. 10–19 points, P <0 .001) and were more likely to receive methylprednisolone pulse therapy (71.6% vs. 49.5%, P < 0.001) than those who did not receive intrathecal therapy. Intrathecal treatment was associated with a higher probability of survival and being free from NPSLE relapse than control treatment among the 386 unmatched patients (P =0.042 by log-rank test) and within 147 propensity score-matched pairs (P =0.032 by log-rank test). In the subgroup of NPSLE patients with increased levels of protein in cerebrospinal fluid, intrathecal treatment had a positive influence on their prognosis (P < 0.001). Conclusions Intrathecal treatment of methotrexate and dexamethasone was associated with a more favorable prognosis of NPSLE and may serve as a valuable additional therapy for NPSLE patients, especially for those with elevated levels of protein in cerebrospinal fluid.

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Impact Analysis of Autoantibody Level and NR2 Antibody Level in Neuropsychiatric SLE Treated by Methylprednisolone Combined with MTX and DXM Intrathecal Injection

Cited by 14 publications

References 25 publications

Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: a prospective, single-center study

Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: a prospective, single-center study

Management of Neuropsychiatric Systemic Lupus Erythematosus: Current Approaches and Future Perspectives

The influence of intrathecal injection of methotrexate and dexamethasone on neuropsychiatric systemic lupus erythematosus (NPSLE): a retrospective cohort study of 386 patients with NPSLE

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