Background Neuropsychiatric manifestations in systemic lupus erythematosus (NPSLE) are one of the most difficult complications of the disease, especially diffuse psychiatric/neuropsychological syndromes (diffuse NPSLE). For the evaluation and the diagnosis of central nervous system manifestations including NPSLE, magnetic resonance imaging (MRI) is a very useful tool to detect the various abnormalities in brain such as acute or chronic changes in cerebrum, cerebellum and brain stem. However, the relationship between brain MRI findings and clinical variables has not been clear in patients with diffuse NPSLE.
Objectives The aim of this study is to investigate the association of various parameters with abnormal findings on brain MRI in patients with diffuse NPSLE.
Methods Fifty-three patients with diffuse NPSLE admitted to Kitasato university hospital and Teikyo university hospital from 1992 to 2012 were exhaustively enrolled in this study. The medical charts were reviewed along with the findings on brain MRI scans. The relationship of MRI abnormalities with various parameters was analyzed.
Results Of 53 patients (37 acute confusional state, 6 psychosis, 3 anxiety disorder, 12 mood disorder and 6 cognitive dysfunction), 25 patients [47.2%] had abnormal MRI findings, including 5 patients with cortical lesions, 18 patients with white matter lesions, 3 patients with meningeal lesions, 1 patient with lesions in cerebellum and brainstem, and 1 patient with cerebral hemorrhage. There was no significant association of MRI abnormalities with certain types of manifestation indiffuse NPSLE. MRI findings were partially or completely ameliorated after treatment in 10 of 17 patients in which follow-up MRI scans were available. The presence of MRI abnormalities was not correlated with the ages at the onset of diffuse NPSLE. However, the disease duration of SLE was significantly longer in patients with abnormal MRI findings (p=0.0284). The presence of MRI abnormalities was not significantly associated with serum anti-DNA, anti-Sm anti-RNP, anti-ribosomal P, or anti-phospholipid antibodies. Of note, IL-6 level in cerebrospinal fluid was significantly elevated in patients with abnormal MRI findings (figure left, p=0.0233). Finally, patients with MRI abnormalities showed significantly higher overall mortality (figure right, HR: 0.223, 95% CI: 0.0601-0.901, p=0.0348).
Conclusions These results indicate that those patients with diffuse NPSLE who showed MRI abnormalities have more severe disease, as evidenced by higher cerebrospinal IL-6 and poorer prognosis. The data also suggest that MRI abnormalities in diffuse NPSLE might be heterogeneous with regard to their reversibility.
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Disclosure of Interest: None Declared