Systemic lupus erythematosus (SLE) is a clinically heterogeneous multi-system disease, that is characterised by the presence of autoantibodies directed against nuclear antigens. The most common manifestations include rash, arthritis, fatigue, but also anaemia, thrombocytopenia, nephritis and neurologic symptoms. The latter remain one of the most challenging of all classification criteria, since lupus patients might present with a multiple array of psychiatric and neurologic symptoms, such as depression, anxiety and personality disorder, dementia, asseptic meningitis, demyelinating syndromes, and cerebrovascular disease.
The aim of this project was to understand the prevalence, morbidity and outcome associated with non-primary neuropsychiatric Lupus erythematosus systemic at our auto-immunity diseases centre. Clinical records of 128 patients followed at the clinic between January 1993 and December 2016 were read, and national registry of Auto-immune diseases was consulted in order to characterise the Lupus cohort.
From all 137 patients assessed, average age was 49, with 93% of all patients being females. The most frequent clinical criteria were malar rash in 72%, arthritis in 51%, hematologic disturbances in 43%, from which the most frequent was lymphopenia.
Amongst all patients, only 6,6% of patients (n=9) presented with severe non-thrombotic neurologic impairment, with one patient presenting with trigeminal neuralgia, 5,8% of patients presenting with magnetic ressonance imaging compatible with cerebritis, with three of the patients overlapping with seizures. However, minor neuropsychiatric impairment was very common, with headache being the most predominant complaint (68,4%), as well as anxiety (77%). All of patients were on a low dose corticosteroid regimen.
Diffuse neuropsychiatric manifestations of SLE remain a diagnostic challenge, because it is very difficult for the physician to understant whether these are caused by SLE or psychological reactions to the stress of coping with a major chronic systemic illness.
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