Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India.
Emergency Medicine, St John's Medical College, Bengaluru, India.
Lupus. 2022 Nov;31(13):1563-1571. doi: 10.1177/09612033221127898. Epub 2022 Sep 22.
To study the prevalence of different NPSLE manifestations in our cohort and to compare clinical and immunological features and outcomes including mortality of patients with NPSLE and SLE controls without NP involvement.
This was a retrospective study in a tertiary care referral centre. All patients of SLE seen in the last 10 years and fulfilling the SLICC criteria with neuropsychiatric manifestations as per the ACR definitions were included. Patients of SLE without NP involvement were sequentially assigned as controls in a ratio of 1:2.
Of the 769 patients diagnosed with SLE from Jan 2011 to December 2020, 128 (16.6%) had NPSLE manifestations as per the ACR definitions. The commonest NPSLE manifestation was seizures (6.5%) followed by cerebrovascular accident (3.9%). NPSLE manifestation occurred at the first presentation of SLE in 99/128 (77.3%) patients and 58 (45.3%) patients had more than one NPSLE manifestation. Lupus anticoagulant and anticardiolipin antibody were tested in 120 patients and were positive in 16 (13.3%) and 12 (10%), respectively. No difference was found in anti-ribosomal , lupus anticoagulant and anticardiolipin antibodies between the cases and controls. Twenty-one (16.4%) deaths occurred in patients with NPSLE (median follow-up of 40 months) as compared to 13 (5%) in controls (median follow-up of 32 months) ( = <0.001). The cumulative survival of patients with NPSLE was lower as compared to controls ( < 0.001). Relapse of NPSLE was seen in 11(8.6%) patients and was associated with mortality ( = 0.017).
Seizures and cerebrovascular accidents are the commonest NPSLE syndromes in our patients. The presence of NPSLE was associated with high mortality in Indian patients with lupus.
研究我们队列中不同神经精神狼疮（NPSLE）表现的患病率，并比较包括死亡率在内的 NPSLE 患者和无神经精神系统受累的系统性红斑狼疮（SLE）对照患者的临床和免疫学特征及结局。
这是一项在三级转诊中心进行的回顾性研究。纳入过去 10 年中根据 SLICC 标准确诊为 SLE 且具有 ACR 定义的神经精神表现的所有患者。按 1:2 的比例，将 SLE 无神经精神系统受累的患者依次作为对照。
在 2011 年 1 月至 2020 年 12 月期间诊断的 769 例 SLE 患者中，有 128 例（16.6%）根据 ACR 定义存在 NPSLE 表现。最常见的 NPSLE 表现是癫痫发作（6.5%），其次是脑血管意外（3.9%）。在 128 例 NPSLE 患者中，有 99 例（77.3%）在首次出现 SLE 时即有 NPSLE 表现，有 58 例（45.3%）患者有不止一种 NPSLE 表现。对 120 例患者进行狼疮抗凝物和抗心磷脂抗体检测，结果阳性分别为 16 例（13.3%）和 12 例（10%）。病例组和对照组之间的抗核糖体抗体、狼疮抗凝物和抗心磷脂抗体无差异。NPSLE 组 21 例（16.4%）死亡（中位随访 40 个月），对照组 13 例（5%）死亡（中位随访 32 个月）（<0.001）。与对照组相比，NPSLE 患者的累积生存率较低（<0.001）。11 例（8.6%）NPSLE 患者出现复发，与死亡率相关（=0.017）。
在我们的患者中，癫痫发作和脑血管意外是最常见的 NPSLE 综合征。NPSLE 的存在与印度狼疮患者的高死亡率相关。
