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Neuropsychiatric Events Common in Lupus

Jun 30, 2021 11:04 am

Neuropsychiatric (NP-SLE) or CNS lupus events range from mild to severe; several recent studies have noted that NPS lupus is common and should be screened for.

A metanalysis of the literature finds 22 studies wherein the mean frequency of NPSLE ranged from 10.6% to 96.4%.  When researchers with the Swiss SLE cohort study (SSCS) looked at their population, NPSLE was found in 28.1%.  This included the most severe events such as cerebrovascular insults (7.1%), seizures (5.3%) and psychosis (6.5%). They found the risk of NPSLE increased with the duration of SLE.

Another large, prospective, international, inception cohort of SLE patients showed that certain subgroups could be identified with a better or worse prognosis of NPSLE. Overall they found that NPSLE events occurred in 52% (955/1,827) of SLE patients, with 31% of these attributeable to SLE.

NPSLE was positively associated with male sex, active SLE, steriod use and concurrent non-SLE NP events excluding headache, active SLE and corticosteroids.

They found less NPSLE in Asians, post-secondary education, and immunosuppressive or anti-malarial drug use.

NP events attributed to SLE had a higher resolution rate than non-SLE NP events.

Resolution of NPSLE was more common with Asians and for central/focal NP events.

Resolution of NPSLE was more common with African race and less common with older age at SLE diagnosis.

Lastly, Govani and Hanly  have reviewed the treatment options for NPSLE and noted that NPSLE occurs in one-third of SLE patients and that the pathogenesis of NPSLE includes ischemic and neuroinflammatory mechanisms. They note that while immunosuppressives (high-dose corticosteroids, azathioprine, cyclophosphamide and mycophenolate mofetil) have been used to varying degrees, a case can be made for the optimal managment of thromboitc risk, metabolic abnormalities, infection, hypertension and other cardiovascular risk factors.

The author has no conflicts of interest to disclose related to this subject

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