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Brain MRI in patients with diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus.

Arinuma Y, Kikuchi H, Wada T, Nagai T, Tanaka S, Oba H, Hirohata S - Lupus Sci Med (2014)

Bottom Line: MRI findings improved after treatment in 10 of 17 patients for whom follow-up studies were available.However, the disease duration of SLE was significantly longer in patients with abnormal MRI findings (p=0.0009).However, there were significant elevations of the CSF protein level (p=0.0106) and the CSF interleukin 6 level (p=0.0225) in patients with abnormal MRI findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Kanagawa , Japan.

ABSTRACT

Background: Manifestations in neuropsychiatric systemic lupus erythematosus (NPSLE), especially active diffuse NPSLE syndromes, are some of the most difficult complications of the disease. For the evaluation and the diagnosis of central nervous system manifestations, including NPSLE, MRI is a very useful tool to detect the various abnormalities. However, the relationship between brain MRI findings and clinical variables has not yet been clarified in patients with diffuse NPSLE.

Objectives: The aim of this study is to investigate the pathogenesis of diffuse NPSLE, by comparing various parameters such as serum autoantibodies and cytokines in cerebrospinal fluid (CSF) with abnormal findings revealed on brain MRIs in patients with diffuse NPSLE.

Methods: Fifty-three patients with diffuse NPSLE admitted to our University Hospital from 1992 to 2012 were exhaustively enrolled in this study. Their medical charts and brain MRI scans were reviewed. The relationship of MRI abnormalities with various parameters was analysed.

Results: As many as 25 of 53 patients (47.2%) had abnormal MRI findings. MRI findings improved after treatment in 10 of 17 patients for whom follow-up studies were available. MRI abnormalities were not correlated with age at the onset of diffuse NPSLE. However, the disease duration of SLE was significantly longer in patients with abnormal MRI findings (p=0.0009). MRI abnormalities were not significantly associated with serum autoantibodies. However, there were significant elevations of the CSF protein level (p=0.0106) and the CSF interleukin 6 level (p=0.0225) in patients with abnormal MRI findings. Patients with MRI abnormalities showed significantly higher overall mortality (p=0.0348).

Conclusions: The results revealed that MRI abnormalities in diffuse NPSLE might be heterogeneous with regard to their reversibility. These data also indicate that patients with diffuse NPSLE and MRI abnormalities have more severe inflammation in the central nervous system related to the activity of diffuse NPSLE, as evidenced by poorer prognosis.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier analysis of the effect of MRI findings on the flare of general systemic lupus erythematosus activities in diffuse neuropsychiatric systemic lupus erythematosus. Statistical significance was evaluated by log-rank test.
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LUPUS2014000050F3: Kaplan-Meier analysis of the effect of MRI findings on the flare of general systemic lupus erythematosus activities in diffuse neuropsychiatric systemic lupus erythematosus. Statistical significance was evaluated by log-rank test.

Mentions: Finally, we retrospectively examined the influences of MRI abnormalities on the prognosis of patients with diffuse NPSLE. During the observation periods (72.6±44.6 months, mean±SD), 12 of the 53 patients (22.6%) experienced exacerbation of general SLE activities requiring an increase in their doses of corticosteroids, with or without the addition of immunosuppressive drugs. Patients without flare-ups of SLE were censored on the date of their last visit. Moreover, two of four patients who died from causes unrelated to SLE were censored on the date of death. As shown in figure 3, the presence of brain MRI abnormalities did not influence the exacerbation of SLE (p=0.8462). The 5-year, 10-year and 15-year mortality rates of the 53 patients were 84.5%, 84.5% and 72.4%, respectively (figure 4A). Thus, 9 of the 53 patients (17.0%) died during the observation periods. The survival duration of the nine patients from the onset of diffuse NPSLE was 20.2±50.0 months (mean±SD). Four of these nine patients, died of causes unrelated to SLE disease activity (three of pneumonia and one of rupture of an aortic aneurysm); and the remaining five patients died of the complications of active SLE, including pulmonary hypertension, catastrophic anti-PL syndrome, thrombotic thrombocytopenic purpura, pneumatosis intestinalis, and cerebritis. Thus, all of the dead patients had severe disease activities or had complications by immunosuppressive therapy such as corticosteroids which had been used due to persistent high disease activities. Brain MRI abnormalities significantly increased the overall mortality rate in patients with diffuse NPSLE (figure 4B).


Brain MRI in patients with diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus.

Arinuma Y, Kikuchi H, Wada T, Nagai T, Tanaka S, Oba H, Hirohata S - Lupus Sci Med (2014)

Kaplan-Meier analysis of the effect of MRI findings on the flare of general systemic lupus erythematosus activities in diffuse neuropsychiatric systemic lupus erythematosus. Statistical significance was evaluated by log-rank test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225739&req=5

LUPUS2014000050F3: Kaplan-Meier analysis of the effect of MRI findings on the flare of general systemic lupus erythematosus activities in diffuse neuropsychiatric systemic lupus erythematosus. Statistical significance was evaluated by log-rank test.
Mentions: Finally, we retrospectively examined the influences of MRI abnormalities on the prognosis of patients with diffuse NPSLE. During the observation periods (72.6±44.6 months, mean±SD), 12 of the 53 patients (22.6%) experienced exacerbation of general SLE activities requiring an increase in their doses of corticosteroids, with or without the addition of immunosuppressive drugs. Patients without flare-ups of SLE were censored on the date of their last visit. Moreover, two of four patients who died from causes unrelated to SLE were censored on the date of death. As shown in figure 3, the presence of brain MRI abnormalities did not influence the exacerbation of SLE (p=0.8462). The 5-year, 10-year and 15-year mortality rates of the 53 patients were 84.5%, 84.5% and 72.4%, respectively (figure 4A). Thus, 9 of the 53 patients (17.0%) died during the observation periods. The survival duration of the nine patients from the onset of diffuse NPSLE was 20.2±50.0 months (mean±SD). Four of these nine patients, died of causes unrelated to SLE disease activity (three of pneumonia and one of rupture of an aortic aneurysm); and the remaining five patients died of the complications of active SLE, including pulmonary hypertension, catastrophic anti-PL syndrome, thrombotic thrombocytopenic purpura, pneumatosis intestinalis, and cerebritis. Thus, all of the dead patients had severe disease activities or had complications by immunosuppressive therapy such as corticosteroids which had been used due to persistent high disease activities. Brain MRI abnormalities significantly increased the overall mortality rate in patients with diffuse NPSLE (figure 4B).

Bottom Line: MRI findings improved after treatment in 10 of 17 patients for whom follow-up studies were available.However, the disease duration of SLE was significantly longer in patients with abnormal MRI findings (p=0.0009).However, there were significant elevations of the CSF protein level (p=0.0106) and the CSF interleukin 6 level (p=0.0225) in patients with abnormal MRI findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Kanagawa , Japan.

ABSTRACT

Background: Manifestations in neuropsychiatric systemic lupus erythematosus (NPSLE), especially active diffuse NPSLE syndromes, are some of the most difficult complications of the disease. For the evaluation and the diagnosis of central nervous system manifestations, including NPSLE, MRI is a very useful tool to detect the various abnormalities. However, the relationship between brain MRI findings and clinical variables has not yet been clarified in patients with diffuse NPSLE.

Objectives: The aim of this study is to investigate the pathogenesis of diffuse NPSLE, by comparing various parameters such as serum autoantibodies and cytokines in cerebrospinal fluid (CSF) with abnormal findings revealed on brain MRIs in patients with diffuse NPSLE.

Methods: Fifty-three patients with diffuse NPSLE admitted to our University Hospital from 1992 to 2012 were exhaustively enrolled in this study. Their medical charts and brain MRI scans were reviewed. The relationship of MRI abnormalities with various parameters was analysed.

Results: As many as 25 of 53 patients (47.2%) had abnormal MRI findings. MRI findings improved after treatment in 10 of 17 patients for whom follow-up studies were available. MRI abnormalities were not correlated with age at the onset of diffuse NPSLE. However, the disease duration of SLE was significantly longer in patients with abnormal MRI findings (p=0.0009). MRI abnormalities were not significantly associated with serum autoantibodies. However, there were significant elevations of the CSF protein level (p=0.0106) and the CSF interleukin 6 level (p=0.0225) in patients with abnormal MRI findings. Patients with MRI abnormalities showed significantly higher overall mortality (p=0.0348).

Conclusions: The results revealed that MRI abnormalities in diffuse NPSLE might be heterogeneous with regard to their reversibility. These data also indicate that patients with diffuse NPSLE and MRI abnormalities have more severe inflammation in the central nervous system related to the activity of diffuse NPSLE, as evidenced by poorer prognosis.

No MeSH data available.


Related in: MedlinePlus