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Hippocampal atrophy in systemic lupus erythematosus
  1. S Appenzeller1,
  2. A D Carnevalle3,
  3. L M Li2,
  4. L T L Costallat1,
  5. F Cendes2
  1. 1Department of Rheumatology, University of Campinas, São Paulo, Brazil
  2. 2Department of Neurology, University of Campinas, São Paulo, Brazil
  3. 3Neuroimaging Laboratory, University of Campinas, São Paulo, Brazil
  1. Correspondence to:
    F Cendes
    Department of Neurology, University of Campinas—UNICAMP, Cidade Universitária, Campinas, São Paulo CEP 13083-970, Brazil; fcendes{at}


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.

  • 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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  • Published Online First 26 January 2006

  • Funding: Grants FAPESP and CNPq (479133/2004-2).

  • Competing interests: None declared.