EXTENDED REPORT

Hippocampal atrophy in systemic lupus erythematosus

S Appenzeller¹, A D Carnevalle³, L M Li², L T L Costallat¹, F Cendes²

¹ Department of Rheumatology, University of Campinas, São Paulo, Brazil
² Department of Neurology, University of Campinas, São Paulo, Brazil
³ Neuroimaging Laboratory, University of Campinas, São Paulo, Brazil

Correspondence to:
F Cendes
Department of Neurology, University of Campinas—UNICAMP, Cidade Universitária, Campinas, São Paulo CEP 13083-970, Brazil; fcendes{at}unicamp.br

Objectives: To determine the frequency and progression of hippocampal atrophy in systemic lupus erythematosus (SLE) and the clinical, laboratory and treatment features associated with its occurrence.

Methods: 150 patients with SLE and 40 healthy volunteers were enrolled in our study. A complete clinical, laboratory and neurological evaluation was performed. Magnetic resonance imaging was carried out using a 2T scanner (Elscint Prestige) and coronal T1-weighted images were used for manual volumetric measurements. Atrophy was defined as values <2 standard deviations from the means of controls.

Results: At entry into the study, the mean right and left hippocampal volumes of patients were significantly smaller than the hippocampal volumes of controls (p<0.001). After the follow-up magnetic resonance imaging, a significant progression of reduction in right and left hippocampal volumes in patients was observed (p<0.001). At entry, atrophy was identified in 43.9% and at follow-up in 66.7% of patients with SLE. Hippocampal atrophy was related to disease duration (p<0.001) total corticosteroid dose (p = 0.01) and history of central nervous system (CNS) manifestations (p = 0.01). Progression of atrophy was associated with cumulative corticosteroid dose (p = 0.01) and number of CNS events (p = 0.01). Patients with cognitive impairment had more severe hippocampal atrophy than those without.

Conclusion: Disease duration, total corticosteroid dose and greater number of CNS manifestations were associated with hippocampal atrophy in patients with SLE. A significant progression of hippocampal atrophy related to total corticosteroid dose and number of CNS events was observed. Further studies are necessary to confirm these findings.

Abbreviations: ACR, American College of Rheumatology; CNS, central nervous system; MRI, magnetic resonance imaging; SLE, systemic lupus erythematosus; SLEDAI, Systemic Lupus Erythematous Disease Activity Index; SLICC/ACR DI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index

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