Reduction of Cerebral and Corpus Callosum Volumes in Childhood‐Onset Systemic Lupus Erythematosus: A Volumetric Magnetic Resonance Imaging Analysis

Abstract

Objective. There have been few studies in which the prevalence of cerebral atrophy in childhood-onset systemic lupus erythematosus (SLE) was evaluated using magnetic resonance imaging (MRI) volumetric measurements. This study was undertaken to determine the prevalence of cerebral and corpus callosum atrophy in childhood-onset SLE and to determine the possible relationships between atrophy and clinical, laboratory, and treatment features of the disease.Methods. We included 76 patients with childhoodonset SLE (69 female and 7 male; median age 16 years) and 66 age-and sex-matched healthy controls. Neurologic manifestations were analyzed according to the American College of Rheumatology (ACR) criteria. These SLE patients were further assessed for clinical and laboratory manifestations of SLE, disease activity (using the SLE Disease Activity Index), damage (using the Systemic Lupus International Collaborating Clinics/ACR Damage Index), and current and cumulative drug exposures. Scans were performed with a Philips 3.0T MRI scanner using a standardized protocol.Results. Childhood-onset SLE patients had significantly smaller cerebral and corpus callosum volumes than controls (median cerebral volume 1,067.9 cm 3 versus 1,172.7 cm 3 and median corpus callosum volume 11.6 cm 3 versus 13.7 cm 3 ; P < 0.001). The presence of structural abnormalities was observed in 42 patients (55.3%) with childhood-onset SLE. The presence of cerebral atrophy was associated with anticardiolipin antibodies (aCL) (P 5 0.02), anti-double-stranded DNA (P 5 0.02), and cumulative corticosteroid dose (P 5 0.04). The presence of corpus callosum atrophy was associated with low complement level (P 5 0.006) and acute confusional state (P 5 0.01). Serum levels of S100B or high molecular weight neurofilament and the presence of anti-ribosomal P were not associated with atrophy.Conclusion. Structural brain abnormalities were observed in 55.3% of the patients and were associated with neuropsychiatric manifestations, aCL, and corticosteroid use. To determine permanent neurologic damage, longitudinal studies must be conducted in these patients.Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease characterized by various clinical manifestations. Approximately 15-20% of patients with SLE develop the disease in childhood or adolescence (1,2). Clinical and laboratory manifestations in adult and childhood-onset SLE are similar; however, in childhood-onset SLE there is a higher prevalence and severity of some manifestations, especially nephritis and

Role of Hepatic Deposited Immunoglobulin G in the Pathogenesis of Liver Damage in Systemic Lupus Erythematosus

“…Although we showed that liver inflammation is related to the dose of lupus IgG, we were surprised that liver damage was not related to the type of autoantibody, because the damage to the brain and kidney was associated with anti-dsDNA Ab ( 42 , 43 ). We found that intrahepatic injection of autoantibody-laden serum from patients with primary Sjogren’s syndrome and rheumatoid arthritis mediated a similar pathological reaction in mice (Figure S8A in Supplementary Material).…”

Clinical Factors Associated with Brain Volume Reduction in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations

“…However, for glucocorticoids, we found a positive correlation between cumulative glucocorticoids dosage and GMV/WMV, which was not found in our previous study ( 24 ). Although we used glucocorticoids in the treatment of SLE including NPSLE, several researchers reported the association or positive correlation of glucocorticoids and brain atrophy or brain lesions, which showed the complex effects of glucocorticoids on CNS in SLE patients ( 15 , 17 , 28 – 31 ). More research studies are needed to reveal the exact effects of glucocorticoids in SLE.…”

Magnetic resonance imaging in neuropsychiatric systemic lupus erythematosus: current state of the art and novel approaches

“…Studies have reported a variable frequency of cerebral atrophy in SLE. 6,11–13 The prevalence and severity of cerebral atrophy identified on brain MRI have been associated with disease duration, 13 aging, 11 the presence of antiphospholipid antibodies, 14,15 the presence of hyperintense WM lesions 11,16 and cumulative organ damage. 15,16 Several studies suggested that the atrophy might be the result of corticosteroid therapy.…”

“…Structural abnormalities may occur in both patients with and without CNS manifestations. 4,6 However, advanced MRI techniques have shown promising results for diagnosis and follow-up of NP manifestations.…”