Bortoluzzi A, Piga M, Silvagni E, Chessa E, Mathieu A, Govoni M
1 Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy.
2 Rheumatology Unit, University Clinic and AOU of Cagliari, Italy.
Lupus. 2019 Apr;28(4):465-474. doi: 10.1177/0961203319828499. Epub 2019 Feb 10.
Despite its potentially significant impact on disease outcome, peripheral nervous system involvement in systemic lupus erythematosus has received little attention.
The objective of this study was to assess the prevalence and clinical features of peripheral nervous system involvement in a large cohort of systemic lupus erythematosus patients.
The records of systemic lupus erythematosus patients examined at two tertiary referral centres over a period of 14 years (from 2000 to 2014) were analyzed. Peripheral nervous system events were ascertained according to the 1999 American College of Rheumatology case definitions and by using an attribution algorithm for neuropsychiatric events. Prevalence of peripheral nervous system in systemic lupus erythematosus and demographic, clinical and laboratory features were assessed. Patients with peripheral nervous system events were compared with a control group of systemic lupus erythematosus patients without peripheral nervous system involvement.
In a retrospective cohort of 1224 patients, the overall prevalence of peripheral nervous system involvement was 6.9% (85 patients, 95% confidence interval 0.06-0.08), with 68% of peripheral nervous system events attributable to systemic lupus erythematosus. Polyneuropathy was the most common manifestation observed (38 events, 39.2%), followed by cranial neuropathy in 30 cases (30.9%) and 12 cases of single (12.4%) or multiple (eight events, 8.2%) mononeuritis. The average age of systemic lupus erythematosus onset was significantly higher in patients with peripheral nervous system events than in controls (mean ± standard deviation: 45.9 ± 14.8 vs. 37.1 ± 14.0) and they were more likely to have higher SLEDAI-2K and SLICC/ACR Damage Index scores, as well as hypertension and livedo reticularis. A subgroup analysis of events deemed to be systemic lupus erythematosus-related provided similar results.
Peripheral nervous system manifestations are a potential complication of systemic lupus erythematosus. Careful neurological assessment should therefore be included in the diagnostic workup of patients with systemic lupus erythematosus, especially in those with later onset and greater damage and disease activity.
尽管外周神经系统受累对疾病结局可能有重大影响，但在系统性红斑狼疮中却很少受到关注。
本研究的目的是评估一大群系统性红斑狼疮患者中外周神经系统受累的患病率和临床特征。
分析了在两个三级转诊中心14年期间（从2000年到2014年）检查的系统性红斑狼疮患者的记录。根据1999年美国风湿病学会病例定义并使用神经精神事件归因算法确定外周神经系统事件。评估系统性红斑狼疮中外周神经系统的患病率以及人口统计学、临床和实验室特征。将发生外周神经系统事件的患者与未发生外周神经系统受累的系统性红斑狼疮患者对照组进行比较。
在1224例患者的回顾性队列中，外周神经系统受累的总体患病率为6.9%（85例患者，95%置信区间0.06 - 0.08），其中68%的外周神经系统事件归因于系统性红斑狼疮。多发性神经病是最常见的表现（38例事件，39.2%），其次是30例（30.9%）颅神经病和12例（12.4%）单发性或8例（8.2%）多发性单神经炎。发生外周神经系统事件的系统性红斑狼疮患者的平均发病年龄显著高于对照组（平均值±标准差：45.9±14.8对37.1±14.0），并且他们更有可能具有更高的SLEDAI - 2K和SLICC/ACR损伤指数评分，以及高血压和网状青斑。对被认为与系统性红斑狼疮相关的事件进行的亚组分析提供了类似的结果。
外周神经系统表现是系统性红斑狼疮的潜在并发症。因此，在系统性红斑狼疮患者的诊断检查中应包括仔细的神经学评估，特别是在发病较晚、损伤和疾病活动度较大的患者中。
