Background Neuropsychiatric systemic lupus erythematosus (NPSLE) is defined as wide range of neurological and psychiatric symptoms due to inflammation and ischemic processes. It is difficult to recognize primary NPSLE because of multiple central and peripheral symptoms.
Objectives The aim of the study was to identified and classified the group of NPSLE patients with evaluation of disease activity.
Methods We observed clinical neuropsychiatric (NP) manifestations in the cohort of 128 Polish patients with SLE. All patients with suspicion of NP symptoms had neuropsychological and imaging examinations. Symptoms of NPSLE were observed in 38 (30%) patients (34 female and 4 male) with average age 38±6 years (range 18–61 yrs), average disease duration 6,6±5,6 years (range 1,0 - 18,0 yrs). Patients were treated with oral and pulse glucocorticoids (GC) and 89% of them standard immunosuppressive drugs (CYC, MMF, AZA,MTX, CsA). As a background therapy 82% of these patients were on chloroquine or hydroksychloroquine (CQ/HCQ). All patients were assessed according to Systemic Lupus Erythematosus Disease Activity Index by SLEDAI (version 2000), Physical Global Assessment (PGA) and damage index (SDI).
Results Central and peripheral NPSLE symptoms were recognized and categorized (Tab 1). All NPSLE patients had symptoms from central nervous system, but only 16% (n=6) of them had peripheral lupus manifestations. Mean SLEDAI score at NP event was very high 29±9,6, but mean SLEDAI score without NP symptoms was 15±8,3 and was connected with musculoskeletal, mucocutaneous, renal and hematological domains respectively n=29, 76%; n=23, 60%; n=11, 29%; n=8, 21%. Low disease activity was estimated at 3% of patients examined.Most of lupus patients (n=37, 97%) had moderate or high disease activity regardless of NP symptoms. In our study group lupus patients during NPSLE symptoms were immunologically active with increased anti-dsDNA antibodies (n=30, 78%) and/or lower complements C3 and/or C4 levels (n=21, 55%).
Conclusions In Polish lupus cohort we observed more frequently lupus-related primary neuropsychiatric symptoms from central nervous system, especially cognitive dysfunctions, mood disorders, cerebrovascular events. Clinical activity of NPSLE patients was rather high and definitely most of patients were immunologically active despite aggressive immunosuppressive treatment and with standard background therapy.
Disclosure of Interest None declared
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