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Neuropsychiatric Manifestations in Systemic Lupus Erythematosus: Prevalence and Association with Antiphospholipid Antibodies
GIOVANNI SANNA, MARIA L. BERTOLACCINI, MARIA J. CUADRADO, HANA LAING, MUNTHER A. KHAMASHTA, ALESSANDRO MATHIEU, and GRAHAM R.V. HUGHES
ABSTRACT.
Methods. Clinical, serological, and imaging data of 323 consecutive patients with SLE were retrospectively reviewed. Neuropsychometric testing was applied by a neuropsychologist. Univariate and multivariate statistical analyses were applied to evaluate the association bewteen NP manifestations, magnetic resonance imaging (MRI) abnormalities, and aPL. Results. In total, 185 patients (57.3%) had NP manifestations at any time during followup. Headache was the most frequent manifestation, present in 78 patients (24%). Cerebrovascular disease (CVD) was diagnosed in 47/323 patients (14.5%), with a total of 57 events. Mood disorders were found in 54 (16.7%), cognitive disorders in 35 (10.8%), and seizures in 27 patients (8.3%). Psychosis was diagnosed in 25 (7.7%), anxiety disorder in 24 (3.7%), and acute confusional state in 12 patients (3.7%). Less common manifestations were polyneuropathy, mononeuritis, myasthenia gravis, cranial neuropathy, myelopathy, chorea, demyelinating disease, and Guillain-Barré syndrome. The presence of aPL was associated with NP manifestations (p < 0.001). Multivariate analysis showed that aPL were independently associated with CVD (OR 6.17, 95% CI 2.94–12.9, p = 0.001), headache (OR 2.04, 95% CI 1.17–3.55, p = 0.01), and seizures (OR 2.89, 95% CI 1.18–7.10, p = 0.02). The presence of lupus anticoagulant (LAC) was independently associated with white matter hyperintensity lesions on MRI (OR 3.0, 95% CI 1.12–8.05, p = 0.027). Conclusion. The new ACR criteria for NPSLE are useful to define NP manifestations in SLE with accuracy. NP manifestations are significantly associated with aPL. CVD, headache, and seizures were independently associated with these antibodies. (J Rheumatol 2003;30:985-92) Key Indexing Terms:
ANTICARDIOLIPIN
From the Lupus Research Unit, The Rayne Institute, and the Department of Psychology, St. Thomas' Hospital, London, UK; and the Centre for Systemic Rheumatic Diseases, Department of Medical Sciences, University of Cagliari, Cagliari, Italy. Supported in part by Lupus UK. G. Sanna, MD, PhD, Lupus Research Unit, The Rayne Institute, Second Chair of Rheumatology, Centre for Systemic Rheumatic Diseases, University of Cagliari; M.L. Bertolaccini, MD; M.J. Cuadrado, MD, PhD; M.A. Khamashta, MD, FRCP, PhD; G.R.V. Hughes, MD, FRCP, Lupus Research Unit, The Rayne Institute; H. Laing, PhD, Department of Psychology, St. Thomas' Hospital; A. Mathieu, MD, Second Chair of Rheumatology, Centre for Systemic Rheumatic Diseases, University of Cagliari. Address reprint requests to Dr. M.A. Khamashta, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, London SE1 7EH, UK. E-mail: munther.khamashta@kcl.ac.uk Submitted April 26, 2002; revision accepted November 27, 2002. |