Background Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by autoantibody production, complement activation and deposition of immune complexes in tissues and organs. According to different authors about 25–79% of the SLE patients have neuropsyhiatric involvement (NPSLE) at same point of the disease course. The latter could be the only and single disease manifestation but often NPSLE is present in patients with active disease.
Objectives Our objective is to present the results from our study about the neuropsychiatric manifestations in patients with SLE. Based on its results we propose a new set of criteria for NPSLE. The use of these criteria for the last 5 years in Bulgarian patients with SLE proved their high sensitivity and specificity.
Methods In order to determine the type and incidence of nervous system (NS) damages clinical, laboratory, and instrumental examinations were performed in a total number of 225 patients with SLE for a total period of 9 years. Depending on the specific features of the clinical course the patients were divided into three groups: with clinically manifested NS damages, without clinically manifested NS damages and with incomplete SLE. Patients with rheumatoid arthritis and healthy controls matched for age and gender were used as control groups.
Results The study showed high percentage (64,44%) of neuropsychiatric manifestations in the SLE patients. Cognitive dysfunctions were found in 49,33% of the SLE patients. According to this set of criteria the NPSLE diagnosis should be made in the presence of at least one indicator from the first group of criteria (seizures, psychosis, cerebrovascular event, lesion of cranial nerves, motor disturbances, quantitative alterations of consciousness) and at least two indicators from the second group of criteria (cognitive dysfunction, headache due to lupus, peripheral neuropathy, MRI changes, EEG changes, ENMG changes, positive aRPA, positive aPL) after excluding other causes than SLE for their occurrence.
Conclusions The use of the proposed criteria of NPSLE with high specificity and sensitivity is of practical value allowing earlier detection of NS damages and introduction of adequate pathogenic treatment.
Disclosure of Interest None declared
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