Clinical features and predictive factors in neuropsychiatric lupus.

BACKGROUND

Neuropsychiatric lupus (NPL) can present with a wide variety of clinical manifestations secondary to major organ involvement. These are often difficult to diagnose and treat with a high mortality.

OBJECTIVE

This study aims to describe the prevalence, clinical features and predictive factors for NPL patients.

METHODS

Patients with SLE were retrospectively reviewed for 10 years, between January 1996 [corrected] and August 2005. The prevalence, clinical features and predictive factors for NPL patients were studied. Neuropsychiatric (NP) syndromes were defined using the American College of Rheumatology (ACR) nomenclature and case definitions.

RESULTS

750 patients with SLE were studied; 13 patients were excluded due to incomplete data. The mean age was 35 +/- 11.7 years and 95.2% were female. The mean SLE disease duration was 6.9 +/ 5.6 years. Eleven of the 19 ACR NP syndromes were identified and NP manifestations occurred in 97 patients (13%) with a total of 103 NP events. Central nervous system (CNS) manifestations accounted for 87% (84 patients), while involvement of the peripheral nervous system (PNS) 13% (13 patients). The three most frequent manifestation were seizures (31.1%), followed by psychoses (223%), and cerebrovascular disease (22.3%). CNS involvement was strongly associated with hematologic and gastrointestinal involvements. The mortality rate in patients with NPSLE was 18.8%.

CONCLUSION

Seizures, psychoses and cerebrovascular disease were the three most common NP features in SLE patients. CNS involvement was strongly associated with hematologic and gastrointestinal involvement.