Ann Rheum Dis 2000;59:120-124 ( February )

Extended report

Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature Birgit Kovacs^a, Thomas L Lafferty^b, Lawrence H Brent^a, Raphael J DeHoratius^b

^a Department of Medicine, Albert Einstein Medical Center, Philadelphia, USA, ^b Department of Medicine, Thomas Jefferson University, Philadelphia, USA

Correspondence to: Dr Brent, Einstein Arthritis Center, Albert Einstein Medical Center, 5501 Old York Road, Korman 103, Philadelphia, PA 19141, USA

Accepted for publication 13 October 1999

OBJECTIVETo give a comprehensive review of transverse myelopathy (TM), a rare but serious condition reported in 1-2% of patients with systemic lupus erythematosus (SLE).
METHODS14 patients with SLE and TM were evaluated and 91 additional cases published in the English and German literature reviewed.
RESULTSTM presented either as the initial manifestation or within five years of the diagnosis of SLE. Most patients presented with a detectable sensory deficit at the thoracic level. In our 14 patients, 22% of the patients showed complete neurological recovery, whereas in the total patient population of 105 (our cases plus those reviewed in the literature), complete recovery was observed in 50%, partial recovery in 29% and no improvement or deterioration in 21%. Treatment with intravenous methylprednisolone followed by cyclophosphamide seemed to be most effective. Seventy per cent of the total patient population had abnormal magnetic resonance imaging findings. In our group of 14 patients, those with higher disease activity (measured by the SLAM) at onset of TM were treated more aggressively (for example, with plasmapheresis and intravenous pulse cyclophosphamide). TM in our patients was associated with antiphospholipid antibodies in 43% of the cases as compared with 64% of the total patient population. Optic neuritis occurred in 48% of the total patient population with SLE and TM, suggesting an association.
CONCLUSIONSTM in SLE is a poorly understood entity. Outcome might be more favourable than previously suggested. There is an association of TM with antiphospholipid antibodies in SLE patients. Treatment including intravenous cyclophosphamide may improve the final outcome. This report emphasises the need for multicentre trials to establish guidelines for optimal treatment.

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© 2000 by Annals of the Rheumatic Diseases
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