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Intractable headaches, ischemic stroke, and seizures are linked to the presence of anti-β2GPI antibodies in patients with systemic lupus erythematosus.

Hawro T, Bogucki A, Krupińska-Kun M, Maurer M, Woźniacka A - PLoS ONE (2015)

Bottom Line: Headaches and ischemic stroke were independently associated with anti-β2GPI-IgM (OR=5.6; p<0.05), and seizures were linked to anti-β2GPI-IgG (OR=11.3; p=0.01).Autoantibodies to β2GPI are linked to non-specific headaches, ischemic stroke and seizures, and show a better predictive value than aCL and LA.These findings may help to improve the diagnosis of NPSLE and should prompt further studies to characterize the role of anti-β2GPI in the pathogenesis of this condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a common and potentially fatal manifestation of SLE. Antiphospholipid antibodies (aPL) such as lupus anticoagulant (LA), anticardiolipin (aCL) and antibodies to β2glycoprotein I (anti-β2GPI), the most important aPL antigen, are thought to play a role in some forms of NPSLE. As of yet, their specific roles in NPSLE manifestations remain to be elucidated.

Methodology/principal findings: 57 SLE patients (53 women) were assessed for LA, aCL and anti-β2GPI twice, to determine persistent positivity. All patients were examined by neurology and psychiatry specialists. 69 healthy subjects were assessed as controls. NPSLE was diagnosed in 74% of patients. Headaches were the most prevalent manifestation of NPSLE (39%), followed by cerebrovascular disease (CVD) (23%), depressive disorders (19.0%), and seizures (14%). NPSLE and non-NPSLE patients showed comparable SLE activity and corticosteroid use. In 65% of patients neuropsychiatric manifestations preceded SLE diagnosis. aPL profiles of NPSLE patients and non-NPSLE patients were similar. Headaches and ischemic stroke were independently associated with anti-β2GPI-IgM (OR=5.6; p<0.05), and seizures were linked to anti-β2GPI-IgG (OR=11.3; p=0.01).

Conclusions: In SLE patients, neuropsychiatric manifestations occur frequently and early, often before the disease is diagnosed. Autoantibodies to β2GPI are linked to non-specific headaches, ischemic stroke and seizures, and show a better predictive value than aCL and LA. These findings may help to improve the diagnosis of NPSLE and should prompt further studies to characterize the role of anti-β2GPI in the pathogenesis of this condition.

No MeSH data available.


Related in: MedlinePlus

Relation of diagnosis of SLE and the onset of neuropsychiatric symptoms.Values are negative in those patients, who developed neuropsychiatric symptoms before they were diagnosed with SLE. Dotted lines show the median intervals between the onset of neuropsychiatric symptoms and diagnosis of SLE, i.e. 2 years in patients who developed neuropsychiatric symptoms before they were diagnosed with SLE and 10 years in patients who developed neuropsychiatric symptoms after they were diagnosed with SLE.
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pone.0119911.g001: Relation of diagnosis of SLE and the onset of neuropsychiatric symptoms.Values are negative in those patients, who developed neuropsychiatric symptoms before they were diagnosed with SLE. Dotted lines show the median intervals between the onset of neuropsychiatric symptoms and diagnosis of SLE, i.e. 2 years in patients who developed neuropsychiatric symptoms before they were diagnosed with SLE and 10 years in patients who developed neuropsychiatric symptoms after they were diagnosed with SLE.

Mentions: In 26 patients it was possible to assess the temporal relationship of the first neuropsychiatric symptoms and SLE diagnosis. In 17 (65.4%) of these NPSLE patients, neuropsychiatric symptoms preceded SLE diagnosis, and in 9 (34.6% of NPSLE patients) the onset of symptoms followed the diagnosis of SLE. In the 17 patients who showed neuropsychiatric symptoms before they were diagnosed with SLE, the median interval was 2 years (lower quartile: 1; upper quartile: 5.5). This was significantly (p<0.01) shorter than the median interval of 10 years (lower quartile: 4; upper quartile: 22.5) in patients who developed neuropsychiatric manifestations after they had been diagnosed with SLE (Fig. 1).


Intractable headaches, ischemic stroke, and seizures are linked to the presence of anti-β2GPI antibodies in patients with systemic lupus erythematosus.

Hawro T, Bogucki A, Krupińska-Kun M, Maurer M, Woźniacka A - PLoS ONE (2015)

Relation of diagnosis of SLE and the onset of neuropsychiatric symptoms.Values are negative in those patients, who developed neuropsychiatric symptoms before they were diagnosed with SLE. Dotted lines show the median intervals between the onset of neuropsychiatric symptoms and diagnosis of SLE, i.e. 2 years in patients who developed neuropsychiatric symptoms before they were diagnosed with SLE and 10 years in patients who developed neuropsychiatric symptoms after they were diagnosed with SLE.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4362944&req=5

pone.0119911.g001: Relation of diagnosis of SLE and the onset of neuropsychiatric symptoms.Values are negative in those patients, who developed neuropsychiatric symptoms before they were diagnosed with SLE. Dotted lines show the median intervals between the onset of neuropsychiatric symptoms and diagnosis of SLE, i.e. 2 years in patients who developed neuropsychiatric symptoms before they were diagnosed with SLE and 10 years in patients who developed neuropsychiatric symptoms after they were diagnosed with SLE.
Mentions: In 26 patients it was possible to assess the temporal relationship of the first neuropsychiatric symptoms and SLE diagnosis. In 17 (65.4%) of these NPSLE patients, neuropsychiatric symptoms preceded SLE diagnosis, and in 9 (34.6% of NPSLE patients) the onset of symptoms followed the diagnosis of SLE. In the 17 patients who showed neuropsychiatric symptoms before they were diagnosed with SLE, the median interval was 2 years (lower quartile: 1; upper quartile: 5.5). This was significantly (p<0.01) shorter than the median interval of 10 years (lower quartile: 4; upper quartile: 22.5) in patients who developed neuropsychiatric manifestations after they had been diagnosed with SLE (Fig. 1).

Bottom Line: Headaches and ischemic stroke were independently associated with anti-β2GPI-IgM (OR=5.6; p<0.05), and seizures were linked to anti-β2GPI-IgG (OR=11.3; p=0.01).Autoantibodies to β2GPI are linked to non-specific headaches, ischemic stroke and seizures, and show a better predictive value than aCL and LA.These findings may help to improve the diagnosis of NPSLE and should prompt further studies to characterize the role of anti-β2GPI in the pathogenesis of this condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a common and potentially fatal manifestation of SLE. Antiphospholipid antibodies (aPL) such as lupus anticoagulant (LA), anticardiolipin (aCL) and antibodies to β2glycoprotein I (anti-β2GPI), the most important aPL antigen, are thought to play a role in some forms of NPSLE. As of yet, their specific roles in NPSLE manifestations remain to be elucidated.

Methodology/principal findings: 57 SLE patients (53 women) were assessed for LA, aCL and anti-β2GPI twice, to determine persistent positivity. All patients were examined by neurology and psychiatry specialists. 69 healthy subjects were assessed as controls. NPSLE was diagnosed in 74% of patients. Headaches were the most prevalent manifestation of NPSLE (39%), followed by cerebrovascular disease (CVD) (23%), depressive disorders (19.0%), and seizures (14%). NPSLE and non-NPSLE patients showed comparable SLE activity and corticosteroid use. In 65% of patients neuropsychiatric manifestations preceded SLE diagnosis. aPL profiles of NPSLE patients and non-NPSLE patients were similar. Headaches and ischemic stroke were independently associated with anti-β2GPI-IgM (OR=5.6; p<0.05), and seizures were linked to anti-β2GPI-IgG (OR=11.3; p=0.01).

Conclusions: In SLE patients, neuropsychiatric manifestations occur frequently and early, often before the disease is diagnosed. Autoantibodies to β2GPI are linked to non-specific headaches, ischemic stroke and seizures, and show a better predictive value than aCL and LA. These findings may help to improve the diagnosis of NPSLE and should prompt further studies to characterize the role of anti-β2GPI in the pathogenesis of this condition.

No MeSH data available.


Related in: MedlinePlus