Risk factors for central nervous system involvement in systemic lupus erythematosus

Abstract

We investigated risk factors for central nervous system (CNS) involvement in systemic lupus erythematosus (SLE), in 32 such patients individually matched 1 : 3 to 96 control SLE patients without CNS events. Univariate analysis showed that CNS involvement was significantly associated with the antiphospholipid syndrome (APS) as well as its features: arterial thrombosis, recurrent fetal loss, livedo reticularis and IgG anticardiolipin (aCL) antibodies in high titres. Other potential associations included cutaneous vasculitic lesions, thrombocytopenia, positive ANA, anti-SS-B/La and low serum levels of C(3) and C(4) complement components, while articular manifestations and discoid rash were significantly less common in patients with neuropsychiatric (NP) disease. In multivariate modeling, CNS involvement was strongly associated with cutaneous vasculitic lesions OR 33, 95% CI 1.5-720) and arterial thromboses (OR 13, 95%CI 0.82-220), and negatively related to the presence of articular manifestations (OR 0.015, 95%CI 0.00-0.17) and discoid rash (OR 0.004, 95%CI 0.00-0.35). Associations with APS-related arterial thromboses and vasculitis point to the importance of arterial vascular pathophysiology in the pathogenesis of NP disease in SLE. Patients with articular manifestations and discoid rash are at very low risk of NP events. Patients with an adverse SLE disease profile may require closer observation and may be the target group for studying pre-emptive interventions.

Effect of TNF antagonists on the productivity of daily work of patients with rheumatoid arthritis

“…The most significant identifier of work disability in patients with RA has been shown to be the HAQ functional disability score. 26,27 These findings, combined with those of the present report, suggest that functional disability may be closely linked to the improvement of productivity but not to the disease activity of RA at baseline.…”

Clinical Manifestations of Neuropsychiatric Systemic Lupus Erythematosus in Chinese Patients

“…The precise mechanisms underlying the high prevalence of these clinical manifestations remain to be further investigated. [24][25][26] There is no single laboratory examination specific for the diagnosis of NPSLE. [27][28][29][30][31] We found that most patients presented with positive ANA, lower levels of serum C3, abnormal erythrocyte sedimentation rate, and higher levels of serum IgG as well as abnormal cranial MRI brain imaging, similar to previous studies.…”

Complement levels and anti-C1q autoantibodies in patients with neuropsychiatric systemic lupus erythematosus

“…5,7,8 Some authors have found an association between NPSLE and low serum levels of C3 and C4 complement components, while increased levels of these proteins and the soluble form of C5b-9 have been found in the cerebrospinal fluid (CSF) of SLE patients. [9][10][11] An enhanced deposition of complement activation products on platelets has also been associated with the development of thrombosis in SLE, a process in which antiphospholipid antibodies (aPL) have been reported to notably collaborate. 12,13 In murine models, both deletion of factor B, a key alternative pathway protein, and inhibition of the classical and alternative complement cascade with the complement inhibitor Crry, demonstrated to alleviate experimental CNS lupus.…”