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AB1009 Neuropsychiatric Disorders in Mexican Children with Systemic Lupus Erythematosus
  1. P.B. Lara-Herrera,
  2. F. Garcia-Rodriguez,
  3. D.R. Salinas-Encinas,
  4. A.D.J. Flores-Pineda,
  5. J.E. Tomala-Haz,
  6. E. Faugier-Fuentes,
  7. M.D.R. Maldonado-Velazquez
  1. Pediatric Rheumatology, Hospital Infantil de México Federico Gomez, Mexico City, Mexico

Abstract

Background Neuropsychiatric systemic lupus erythematosus (SLE) encompasses a wide array of central and peripheral nervous system manifestations that develops in almost 40% of patients with recent diagnosis of SLE. These manifestations continue to be one of the most challenging aspects of the disease since diagnosis and therapeutic approach are still difficult and mainly based on clinical expertise. There is lack of information regarding neuropsychiatric manifestations in Mexican patients with SLE.

Objectives The aim of this study is to report clinical characteristics and outcomes of a cohort of Mexican patients with neuropsychiatric SLE.

Methods To describe neuropsychiatric SLE pattern and follow-up of a cohort of 34 Mexican children at the Hospital Infantil de Mexico Federico Gomez during a 3-year period. Descriptive data, parametric, non parametric statistics and Kaplan-Meier graphs was used to analyze disease remission.

Results The mean age at diagnosis was 13 (SD 3.1) years, most of them was female (94%) and 28 (82%) presented neuropsychiatric manifestations at the time of LES diagnosis. The main symptom was headache (41%) followed by behavior alterations (17%), seizures (17%) and psychosis (12%). Image studies were useful in diagnosis, MRI was positive in 28 (82%) patients while SPECT in only 10 (29%) cases. Complement was diminished in almost half of the patients. Autoantibodies were related with neuropsychiatric symptoms in most of the patients, ANAs and anti-dsDNA antibodies were the most prevalent (94% and 82%, respectively), followed by one or more antiphospholipid antibodies (58%). Antiribosomal P protein antibodies were measured in half of the patients in which 8 (50%) were positives. Other manifestations like hematological or nephritis were presented in 24 (70%) and 16 (47%), respectively.

Treatment was based on cyclophpsphamide IV pulses alone or combined with oral either azathioprine or MMF. The patients completed a mean follow-up of 23 months, 28 (82%) patients were in remission after the initial 6 moths induction period. Mean time to remission was 5 (SD 0.6) months. Relapse was presented in four (12%) patients in a mean time of 10 months. Two patients need to move to rituximab treatment.

Conclusions In conclusion, pediatric rheumatologists should be aware of the frequency of neuropsychiatric disturbances in Mexican Children with SLE. Systematic assessment to provide prompt diagnosis and adequate care should be critical part of these patients, as we describe a good response to standard treatment in our population.

References

  1. Nishimura et al. New-onset psychiatric disorders after corticosteroid therapy in systemic lupus erythematosus: an observational case-series study. J Neurol (2014) 261:2150–2158.

  2. Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: pathogenesis and biomarkers. Nat Rev Neurol. 2014 Oct;10(10):579-96.

  3. Fietta P, Fietta P, Delsante G. Psychiatric and neuropsychological manifestations of systemic lupus erythematosus. Acta Biomed. 2011 Aug;82(2):97-114.

Disclosure of Interest None declared

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