Neuropsychiatric manifestations in patients with systemic lupus erythematosus: A study from Iran

Hajighaemi, Fatemeh; Etemadifar, Masoud; Bonakdar, Zahra Sayed

Neuropsychiatric manifestations in patients with systemic lupus erythematosus: A study from Iran

Authors

¹ School of Medicine, Azad Najaf Abad University, Isfahan, Iran

² Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, India

³ Department of Rheumatology and Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious and well-known complication of systemic lupus erythematosus (SLE). There is limited evidence about the prevalence of NPSLE and its manifestations in Iran. The aim of this study was to study clinical and demographic characteristics of patients with NPSLE in an Iranian population.
Materials and Methods: This was a cross-sectional study that was undertaken in two referral Clinics of Neurological and Rheumatological Disorders in Alzahra Hospital, Isfahan, Iran. Between March 2004 and June 2010, medical records of registered patients with SLE were examined. NPSLE was characterized using the American College of Rheumatology case definitions. Descriptive statistics and logistic regression were performed for statistical assessment.

Results: Among 556 patients with SLE, 121 (21.7%) patients were diagnosed as NPSLE and enrolled in the study. Of whom, 94 patients were female (77.7%) and 27 patients were male (22.3%) with a female to male ratio of 3.48:1. The most common NPSLE manifestations were headache (38.8%), cerebrovascular disease (CVD) (38.8%) and seizure (26.4%). Thirty-nine patients have psychiatric disorders. Among them, 32 patients (26.4%) have periods of psychosis and mood disorder was found in 6 patients (5%).
Conclusions: We identified NPSLE manifestations in 21.7% of patients; headache and CVD were the most frequent neurological manifestations. Continued studies into the pathogenesis of neurological involvement in patients with SLE are warranted.

Keywords

References

1.	Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum 2010;39:257-68.
2.	Bertsias GK, Boumpas DT. Pathogenesis, diagnosis and management of neuropsychiatric SLE manifestations. Nat Rev Rheumatol 2010;6:358-67.
3.	Popescu A, Kao AH. Neuropsychiatric systemic lupus erythematosus. Curr Neuropharmacol 2011;9:449-57.
4.	Wang PI, Cagnoli PC, McCune WJ, Schmidt-Wilcke T, Lowe SE, Graft CC, et al. Perfusion-weighted MR imaging in cerebral lupus erythematosus. Acad Radiol 2012;19:965-70.
5.	Liang M, Corzillius M, Bae S, Lew R, Fortin P, Gordon C, et al. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999;42:599-608.
6.	Dong J, Li H, Wang JB, Yao Y, Yang QR. Predictors for neuropsychiatric development in Chinese adolescents with systemic lupus erythematosus. Rheumatol Int 2012;32:2681-6.
7.	Borchers AT, Naguwa SM, Shoenfeld Y, Gershwin ME. The geoepidemiology of systemic lupus erythematosus. Autoimmun Rev 2010;9:A277-87.
8.	Mok CC, Lau CS, Wong RW. Neuropsychiatric manifestations and their clinical associations in southern Chinese patients with systemic lupus erythematosus. J Rheumatol 2001;28:766-71.
9.	Hanly JG, McCurdy G, Fougere L, Douglas JA, Thompson K. Neuropsychiatric events in systemic lupus erythematosus: Attribution and clinical significance. J Rheumatol 2004;31:2156-62.
10.	Ainiala H, Loukkola J, Peltola J, Korpela M, Hietaharju A. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology 2001;57:496-500.
11.	Sanna G, Bertolaccini ML, Cuadrado MJ, Laing H, Khamashta MA, Mathieu A, et al. Neuropsychiatric manifestations in systemic lupus erythematosus: Prevalence and association with antiphospholipid antibodies. J Rheumatol 2003;30:985-92.
12.	Brey RL, Holliday SL, Saklad AR, Navarrete MG, Hermosillo-Romo D, Stallworth CL, et al. Neuropsychiatric syndromes in lupus: Prevalence using standardized definitions. Neurology 2002;58:1214-20.
13.	Sibbitt WL Jr, Brandt JR, Johnson CR, Maldonado ME, Patel SR, Ford CC, et al. The incidence and prevalence of neuropsychiatric syndromes in pediatric onset systemic lupus erythematosus. J Rheumatol 2002;29:1536-42.
14.	Borhani Haghighi A, Haza SG. Neuropsychiatric manifestations of systemic lupus erythematosus: Iranian experience. Ann Indian Acad Neurol 2010;13:108-11.
15.	Akbarian M, Faezi ST, Gharibdoost F, Shahram F, Nadji A, Jamshidi AR, et al. Systemic lupus erythematosus in Iran: A study of 2280 patients over 33 years. Int J Rheum Dis 2010;13:374-9.
16.	Mok CC, To CH, Mak A. Neuropsychiatric damage in southern Chinese patients with systemic lupus erythematosus. Medicine (Baltimore) 2006;85:221-8.
17.	Avčin T, Benseler SM, Tyrrell PN, Čučnik S, Silverman ED. A followup study of antiphospholipid antibodies and associated neuropsychiatric manifestations in 137 children with systemic lupus erythematosus. Arthritis Care Res 2008;59:206-13.
18.	Unterman A, Nolte JE, Boaz M, Abady M, Shoenfeld Y, Zandman-Goddard G. Neuropsychiatric syndromes in systemic lupus erythematosus: A meta-analysis. Semin Arthritis Rheum 2011;41:1-11.
19.	Hiraki LT, Benseler SM, Tyrrell PN, Harvey E, Hebert D, Silverman ED. Ethnic differences in pediatric systemic lupus erythematosus. J Rheumatol 2009;36:2539-46.
20.	Abdel-Nasser AM, Ghaleb RM, Mahmoud JA, Khairy W, Mahmoud RM. Association of anti-ribosomalP protein antibodies with neuropsychiatric and other manifestations of systemic lupus erythematosus. Clin Rheumatol 2008;27:1377-85.
21.	Appenzeller S, Rondina JM, Li LM, Costallat LT, Cendes F. Cerebral and corpus callosum atrophy in systemic lupus erythematosus. Arthritis Rheum 2005;52:2783-9.
22.	Robert M, Sunitha R, Thulaseedharan NK. Neuropsychiatric manifestations systemic lupus erythematosus: A study from South India. Neurol India 2006;54:75-7. [PUBMED]
23.	Mitsikostas DD, Sfikakis PP, Goadsby PJ. A meta-analysis for headache in systemic lupus erythematosus: The evidence and the myth. Brain 2004;127:1200-9.
24.	Bruns A, Meyer O. Neuropsychiatric manifestations of systemic lupus erythematosus. Joint Bone Spine 2006;73:639-45.
25.	Denburg SD, Denburg JA. Cognitive dysfunction and antiphospholipid antibodies in systemic lupus erythematosus. Lupus 2003;12:883-90.
26.	Breitbach SA, Alexander RW, Daltroy LH, Liang MH, Boll TJ, Karlson EW, et al. Determinants of cognitive performance in systemic lupus erythematosus. J Clin Exp Neuropsychol 1998;20:157-66.
27.	Stojanovich L, Zandman-Goddard G, Pavlovich S, Sikanich N. Psychiatric manifestations in systemic lupus erythematosus. Autoimmun Rev 2007;6:421-6.
28.	Afeltra A, Garzia P, Mitterhofer AP, Vadacca M, Galluzzo S, Del Porto F, et al. Neuropsychiatric lupus syndromes: Relationship with antiphospholipid antibodies. Neurology 2003;61:108-10.
29.	Efthimiou P, Blanco M. Pathogenesis of neuropsychiatric systemic lupus erythematosus and potential biomarkers. Mod Rheumatol 2009;19:457-68.
30.	Steup-Beekman GM, Zirkzee EJ, Cohen D, Gahrmann BM, Emmer BJ, Steens SC, et al. Neuropsychiatric manifestations in patients with systemic lupus erythematosus: Epidemiology and radiology pointing to an immune-mediated cause. Ann Rheum Dis 2013;72 Suppl 2:ii76-9.

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