Background Neuropsychiatric systemic lupus erythematosus (NPSLE), especially diffuse psychiatric/neuropsychological syndromes (diffuse NPSLE), is one of the most difficult complications of the disease. For the evaluation and the diagnosis of central nervous system manifestations, including NPSLE, brain MRI is a very useful tool to detect the various abnormalities. We previously disclosed that patients with diffuse NPSLE and MRI abnormalities have more severe inflammation in the central nervous system compared with those without MRI abnormalities, as evidenced by poorer prognosis. Of note, acute confusional state (ACS) is the most recalcitrant manifestation in diffuse NPSLE. However, it remains unclear whether abnormalities in brain MRI still have any influences in patients with ACS.
Objectives The aim of this study is to explore the differences in clinical characteristic between ACS patients with and without MRI abnormalities.
Methods Thirty-six patients with ACS admitted to our University Hospitals from 1992 to 2015 were exhaustively enrolled in this study. Their medical charts and brain MRI scans were reviewed. The relationship of MRI abnormalities with various parameters was analyzed.
Results As many as 19 of 36 patients (52.8%) had abnormal MRI findings. MRI findings improved after treatment in 14 of 19 patients for whom follow-up studies were available. Among the 5 patients without improvement of MRI findings, 4 patients died from active NPSLE itself. MRI abnormalities were not correlated with the age at the onset of ACS, the disease duration of SLE, the presence of anti-DNA antibody, anti-phospholipid antibodies, or anti-ribosomal P antibodies, and the levels of IL-6 in sera or cerebrospinal fluid. Notably, MRI abnormalities were significantly associated with the presence of serum anti-Sm antibodies (p=0.0005). Finally, the presence of MRI abnormalities in patients with ACS significantly increased the mortality (p=0.0013, HR=10.36 [95% CI: 2.487–43.19]) (figure).
Conclusions These results demonstrate that patients with ACS of diffuse NPSLE with MRI abnormalities have more severe inflammation in the central nervous system, as evidenced by poorer prognosis. The data also indicate that anti-Sm in involved in the development of MRI abnormalities in ACS.
Disclosure of Interest None declared