Tumor necrosis factor-alpha and neuropsychiatric lupus erythematosus: relation to single photon emission computed tomography findings

• Published in: Modern rheumatology Vol. 13; no. 3; pp. 250 - 255
• Main Authors: El-Zorkany, Bassel K., Mahmoud, Geilan A., Shahin, Hesham A., Moustafa, Hosna, Shahin, Amira A.
• Format: Journal Article
• Language: English
• Published: United States Informa Healthcare 01.09.2003; Taylor & Francis
• Subjects: Neuropsychiatric lupus erythematosus (NPLE); Neuropsychiatry; Single photon emission computed tomography (SPECT); Systemic lupus erythematosus (SLE); Tumor necrosis factor-α (TNF-α)
• ISSN: 1439-7595; 1439-7609
• DOI: 10.3109/s10165-003-0231-z

Abstract This study was designed to highlight the relation of tumor necrosis factor-α (TNF-α) to neuropsychiatric lupus (NPLE) manifestations. The relation of TNF-α to the type of single photon emission computed tomography (SPECT) findings in this context was also studied. Twenty-one systemic lupus erythematosus (SLE) females, mean age 27.57 ± 9.89 years, and twenty age-matched normal females (controls), were subjected to TNF-α assessment. Different clinical and neuropsychiatric manifestations were evaluated. SPECT was carried out for all patients. The results showed that the mean TNF-α level (pg/ml) was significantly raised in patients compared with controls (167.8 ± 102.5 versus 64 ± 50.2, respectively, P < 0.005). Thirteen patients (69.1%) had NPLE manifestations. NPLE patients had a significantly higher mean TNF-α than patients without NPLE (203 ± 102.8 versus 109 ± 47.3, respectively, P < 0.03). Positive SPECT findings were found in 18 lupus patients (85.7%), including all 13 patients with NPLE (100% sensitivity), with a multiple focal pattern of hypoperfusion being the most frequent type (9/13), followed by diffuse (3/13), and then single focal pattern (1/13). The mean TNF-α was significantly higher in patients with multiple focal pattern (P < 0.001). In conclusion, results of this work support the hypothesis that TNF-α could be involved in the pathogenesis of NPLE, and hence, it could be speculated that the evolving anti-TNF therapy can play a potential role in the management of this disease.