Pathogenesis and treatment of neuropsychiatric systemic lupus erythematosus: A review

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease with a complex pathogenesis. Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious complication of SLE that involves the nervous system and produces neurological or psychiatric symptoms. After decades of research, it is now believed that the diverse clinical manifestations of NPSLE are associated with intricate mechanisms, and that genetic factors, blood-brain barrier dysfunction, vascular lesions, multiple autoimmune antibodies, cytokines, and neuronal cell death may all contribute to the development of NPSLE. The complexity and diversity of NPSLE manifestations and the clinical overlap with other related neurological or psychiatric disorders make its accurate diagnosis difficult and time-consuming. Therefore, in this review, we describe the known pathogenesis and potential causative factors of NPSLE and briefly outline its treatment that may help in the diagnosis and treatment of NPSLE.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

“…In regards to wasp stings, a report comparing HP + continuous venovenous hemodiafiltration (CVVHDF) versus TPE + CVVHDF, found no difference in survival (Yuan, 2016). However, a retrospective study of patients with at least 30 wasp stings observed TPE reduced mortality compared to continuous venovenous hemofiltration or HP (Liu, 2022). Patients with snakebites may develop a thrombotic microangiopathy (TMA).…”

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

“…Various serum markers [interleukin (IL)-6, interferon alpha (IFN-α), microRNA(miR)-23a, miR-155, neuron specific enolase, S100A8/A9], CSF markers [IL-6, IL-10, IL-13, IL-18, neopterin, IFN-α, granulocyte colony stimulating factor (G-CSF)], and serum/CSF antibodies [anti-NDMAR, anti-RP, anti-ganglioside, anti-microtubule associated protein 2 (anti-MAP2), anti-glial fibrillary acidic protein (anti-GFAP)] have all been postulated. 23,[49][50][51][52] Similarly, recent aptamer-based screening of CSF in NPSLE patients has revealed several promising biomarkers, including lipocalin 2, macrophage colony stimulating factor (M-CSF), IgM and complement C3. 50 Their availability for clinical use in the future could help define pathogenesis, target treatments, and improve prognosis.…”

Association between Inflammation and Thrombotic Pathway Link with Pathogenesis of Depression and Anxiety in SLE Patients

“…Systemic lupus erythematosus (SLE) is an autoimmune disease with systemic implications that can affect multiple organisms. Psychiatric manifestations represent a complication of this condition, a phenomenon known as neuropsychiatric systemic lupus erythematosus (NPSLE) directly related to SLE [ 1 ]. NPSLE could be the singular or initial manifestation of SLE, and in roughly 30% of individuals with neuropsychiatric symptoms, SLE is the direct cause.…”

“…Thus, molecular elements associated with coagulopathy which may cause a neurodegenerative response, are also investigated, in addition to the inflammatory autoimmune response. Still, essential elements are also identified that intervene in the blood barrier of the central nervous system, affecting the permeability and allowing the penetration of specific autoantibodies and immune cells in the central nervous system with mediated neuronal damage [ 1 ]. Two paths of pathological mechanisms that may contribute to SLE’s neuropsychiatric manifestations have been identified and addressed in the specialized literature [ 12 ].…”

“…SLE has been associated with 116 antibodies, and NPSLE has been associated with the presence of 20 autoantibodies, of which eleven are related to the central nervous system. Still, the neuropsychiatric manifestations have not been fully elucidated or associated with a specific autoantibody [ 1 ].…”