Prevalence and characteristics of neuropsychiatric involvement in an Egyptian cohort of systemic lupus erythematosus patients: a single-center retrospective cohort

• Published in: Egyptian Rheumatology and Rehabilitation Vol. 47; no. 1; pp. 18 - 8
• Main Authors: M Medhat, Basma, Moghazy, Abdelkawy, Eissa, Mervat
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2020; Springer Nature B.V; SpringerOpen
• Subjects: Age; Alopecia; Anemia; Antibodies; Antiphospholipid syndrome; Autoimmune diseases; Baldness; Deoxyribonucleic acid; Disease activity; Disease damage; DNA; Egyptian; Fever; Gender; Leukopenia; Lupus; Medical records; Medicine; Medicine & Public Health; Neuropsychiatric; Pericarditis; Pleural effusion; Psychosis; Rehabilitation; Rheumatology; Systemic lupus erythematosus; Thrombocytopenia; Ulcers; Neuropsychiatric; Disease activity; Systemic lupus erythematosus; Egyptian; Disease damage; Antiphospholipid syndrome
• DOI: 10.1186/s43166-020-00016-3
• ISSN: 1110-161X

Background The aim of this study was to retrospectively investigate the prevalence and characteristics of neuropsychiatric (NP) involvement in a cohort of systemic lupus erythematosus (SLE) patients from a single tertiary center. Results Of 301 included patients’ medical records, the prevalence of NPSLE, that was defined according to the American College of Rheumatology Nomenclature of 1999, was 33.5% (101/301), of whom 10 (9.9%) were males. The mean age at the last visit of patients with NP involvement was 29.1 ± 8.2 years, whereas the mean age at onset was 21.9 ± 7.3 years, and the mean disease duration was 89.8 ± 59.4 months. The most common NP manifestations were psychosis [34/101 (33.7%)], followed by seizures [22/101 (21.8%)]. Compared to those without NPSLE, patients with NP involvement were characterized by having a younger age of onset ( p < 0.001) had a longer disease duration ( p = 0.02). Of the cumulative characteristics recorded, NPSLE patients showed a higher prevalence of cutaneous vasculitis ( p = 0.002), discoid rash ( p = 0.03), pleurisy and pleural effusion ( p = 0.004, p = 0.03, respectively), pericarditis ( p = 0.007), thrombocytopenia ( p = 0.04), and secondary antiphospholipid (APS) ( p = 0.04); however, there was no difference in any of the included serologic features between the two groups. Patients with NPSLE had a higher median disease activity score [Systemic Lupus Erythematosus Disease Activity Index-2 K (SLEDAI-2 K)] at the disease onset ( p = 0.008), yet it was comparable to those without NP involvement at the last visit ( p = 0.3). NPSLE patients demonstrated a higher median damage score ( p < 0.001) that was assessed according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score. NPSLE patients with secondary APS showed a higher prevalence of cerebrovascular accidents (CVA) ( p < 0.001), while those without APS developed psychosis more frequently ( p = 0.03). Conclusion Neuropsychiatric SLE patients (33.5%) demonstrated a younger age of onset, higher prevalence of secondary APS and distinct clinical characteristics, and had higher disease damage. APS-positive NPSLE patients had a higher prevalence of CVA, while APS-negative patients showed a higher prevalence of psychosis.