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Comparison of systemic lupus erythematosus patients and healthy individuals in terms of autobiographical memory, mood, and cognitive emotion regulation. Cogn Process 2020; 22:131-139. [PMID: 32494884 DOI: 10.1007/s10339-020-00973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown cause. It affects different organs in the body. Neuropsychiatric manifestations are among the adverse effects of this disease. Considering the importance of neuropsychiatric manifestations, especially memory dysfunction and mood disorders, early neuropsychological evaluation and serious rehabilitation programs are needed. The present study aimed to compare SLE patients and healthy individuals in terms of autobiographical memory, mood, and cognitive emotion regulation. A sample of 30 SLE patients and 30 healthy individuals was selected by the convenience sampling method. The sample was evaluated by tests such as the Autobiographical Memory Test, the Beck Depression Inventory-second edition, and the Cognitive Emotion Regulation Questionnaire. The data were analyzed by the univariate analysis of variance, multivariate analysis of variance, and the Mann-Whitney U tests. The results of the study revealed a significant difference (p < .01) between SLE patients and healthy individuals in terms of autobiographical memory functioning in retrieving past memories and delay in retrieving memories. A significant difference (p < .001) was also found between SLE patients and healthy individuals in terms of mood. However, no significant difference was observed in terms of cognitive emotion regulation. Based on the results of this study, SLE patients' memory, especially autobiographical memory, and their mood are adversely affected by the disease-related neurological damage.
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Moustafa AT, Moazzami M, Engel L, Bangert E, Hassanein M, Marzouk S, Kravtsenyuk M, Fung W, Eder L, Su J, Wither JE, Touma Z. Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 50:84-94. [PMID: 31303437 DOI: 10.1016/j.semarthrit.2019.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To systematically review and synthesize literature on 1) the overall prevalence of depression and anxiety in SLE patients in identified studies, and 2) the pooled prevalence per metrics of depression and anxiety in adult SLE patients. METHODS This review used (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines and in-depth searches in four databases (1954-2016; Ovid-based Medline, Embase, PsycINFO and CINAHL) to identify articles on the prevalence of depression and/or anxiety in adult SLE patients. Included studies were critically appraised and analyzed. The prevalence of depression and anxiety was studied for all included studies, and whenever possible, pooled prevalence (PP) was determined for more commonly used metrics. Statistical and publication bias was assessed using funnel plots. RESULT A total of 3103 references were identified, 226 were selected for detailed review and 72 were included in the final analysis. OVERALL PREVALENCE The depression PP, obtained from 69 studies representing 23,386 SLE patients, was 35.0% (95% CI: 29.9%-40.3%). The anxiety PP, obtained from 38 studies representing 4439 SLE patients, was 25.8% (95% CI: 19.2%-32.9%). PREVALENCE PER METRICS USED The more commonly used instruments included the Centre for Epidemiological Studies - Depression (CES-D), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scales (HADS-A/D), and Hamilton Rating Scales for Depression/Anxiety (HAM-D/A)]. The CES-D was utilized in 13 studies including 1856 SLE patients; depression PP was 41.5% (95% CI: 35.1%-48.1%). The BDI was utilized in 14 studies including 1355 SLE patients and the BAI in 3 studies including 489 patients; depression PP was 39.9% (95% CI: 31.1%-49.1) and anxiety PP was 38.4% (95% CI: 34.2%-42.8%). The HADS-D was utilized in 14 studies including 1238 SLE patients and the HADS-A in 12 studies including 1099 patients respectively; its depression PP was 24.4% (95% CI: 19.1%-30.1%) and anxiety PP was 38.3% (95% CI: 29.1%-47.9%). The HAM-D was utilized in 4 studies including 267 SLE patients and the HAM-A in 4 studies including 213 patients respectively; its depression PP was 40.0% (95% CI: 23.0%-59.0%) and anxiety PP was 39.0% (95% CI: 32.0%-45.0%). CONCLUSION There was high variability in the prevalence of depression and anxiety, ranging from 8.7%-78.6% and 1.1%-71.4%, respectively. This could be attributed to the lack of consistency in the metrics used and its definition for depression and anxiety in SLE. Studies that used a specific metric, such as the CES-D, BDI or HAM-D, yielded similar depression prevalence. The HADS-D had the lowest prevalence. All metrics of anxiety yielded similar anxiety prevalence.
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Affiliation(s)
- Ahmed T Moustafa
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Mitra Moazzami
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Lisa Engel
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Elvira Bangert
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Mohamed Hassanein
- Michigan State University, College of Human Medicine, East Lansing, Michigan, United States.
| | - Sherief Marzouk
- Lecturer, Faculty of Medicine, Department of Psychiatry, Neuropsychiatry Division, University of Toronto, Toronto, Ontario, Canada.
| | - Maryana Kravtsenyuk
- Forensic Psychiatrist, Alberta Hospital Edmonton, Assistant Clinical Professor, Department of Psychiatry, University of Alberta, Alberta, Canada.
| | - William Fung
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Lihi Eder
- Assistant Professor of Medicine, University of Toronto, Women's College Research Institute, Toronto, Ontario, Canada.
| | - Jiandong Su
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Joan E Wither
- Departments of Medicine and Immunology, University of Toronto, Division of Rheumatology, Toronto Western Hospital, Senior Scientist, Krembil Research Institute, Toronto, Ontario, Canada.
| | - Zahi Touma
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, EW, 1-412, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
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Vivaldo JF, de Amorim JC, Julio PR, de Oliveira RJ, Appenzeller S. Definition of NPSLE: Does the ACR Nomenclature Still Hold? Front Med (Lausanne) 2018; 5:138. [PMID: 29904630 PMCID: PMC5991071 DOI: 10.3389/fmed.2018.00138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/24/2018] [Indexed: 01/17/2023] Open
Abstract
Systemic lupus erythematosus (SLE) patients have frequently neuropsychiatric manifestations. From the first description of coma in 1875, a variety of manifestations has been described to occur in SLE. However, the lack of standardization reduced the comparability of published studies. In 1999, the American College of Rheumatology published guidelines to define neuropsychiatric nomenclature in SLE. This was the first step toward uniform diagnostic criteria. Several studies have been published since then applying the ACR criteria and frequencies of different manifestations can now be compared between cohorts. Although these criteria are diagnostic, therapeutic approach to different manifestations varies according to nature and severity of the manifestations. Herby, we will review the different definition for NPSLE published, and determine advantages and limitation.
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Affiliation(s)
- Jessica Fernandes Vivaldo
- Autoimmune Lab, School of Medical Science, University of Campinas, Campinas, Brazil
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Jaqueline Cristina de Amorim
- Autoimmune Lab, School of Medical Science, University of Campinas, Campinas, Brazil
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Paulo Rogério Julio
- Autoimmune Lab, School of Medical Science, University of Campinas, Campinas, Brazil
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Rodrigo Joel de Oliveira
- Autoimmune Lab, School of Medical Science, University of Campinas, Campinas, Brazil
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Simone Appenzeller
- Autoimmune Lab, School of Medical Science, University of Campinas, Campinas, Brazil
- Rheumatology Unit, School of Medical Science, University of Campinas, Campinas, Brazil
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Muhammed H, Goyal M, Lal V, Singh S, Dhir V. Neuropsychiatric manifestations are not uncommon in Indian lupus patients and negatively affect quality of life. Lupus 2018; 27:688-693. [PMID: 29241417 DOI: 10.1177/0961203317747720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Objectives The objectives of this paper are to look at the prevalence of neuropsychiatric manifestations and assess their impact on quality of life in North Indian lupus patients. Methods The study included consecutive patients with systemic lupus erythematosus (SLE) who were older than 18 years and met the SLICC 2012 criteria. A diagnosis of a neuropsychiatric syndrome was made as per ACR 1999 definitions. Manifestations occurring at any point in time after the diagnosis of SLE were considered if a reliable history and medical records were available. Quality of life was assessed by EuroQol-5D questionnaire. Means were compared by student t test for normally distributed data. Comparison of quality of life between groups was performed by the Kruskal-Wallis test and Mann-Whitney U test. Results This study included 101 patients of SLE with mean (±SD) age of 32.3 ± 10.0 years and a majority ( n = 92) were females. Mean (±SD) age of diagnosis of SLE was 27.8 ± 9.2 years and disease duration (after diagnosis) was 4.6 ± 4.5 years. Thirty-three patients had neuropsychiatric manifestations with a total of 42 events. The most common manifestation was headache (10%) followed by anxiety disorder (5%) and peripheral neuropathy (9%). Other NPSLE syndromes observed in the study are seizure (4%), cognitive dysfunction (4%), depression (4%), acute confusional state (2%), autonomic neuropathy (2%), movement disorder (1%), and mononeuritis multiplex (1%). On comparing the groups of NPSLE, nephritis, and neither, there was a significant difference in mobility, self-care, pain, and worry. On post hoc test, there was a significant difference between the NPSLE and neither group. Conclusion Neuropsychiatric manifestations significantly affect quality of life in North Indian SLE patients.
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Affiliation(s)
- H Muhammed
- 1 Department of Internal Medicine, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - M Goyal
- 2 Department of Neurology, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - V Lal
- 2 Department of Neurology, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - S Singh
- 3 Department of Psychiatry, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - V Dhir
- 1 Department of Internal Medicine, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India
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Abstract
The link between systemic autoimmunity, brain pathology, and aberrant behavior is still a largely unexplored field of biomedical science. Accumulating evidence points to causal relationships between immune factors, neurodegeneration, and neuropsychiatric manifestations. By documenting autoimmunity-associated neuronal degeneration and cytotoxicity of the cerebrospinal fluid from disease-affected subjects, the murine MRL model had shown high validity in revealing principal pathogenic circuits. In addition, unlike any other autoimmune strain, MRL mice produce antibodies commonly found in patients suffering from lupus and other autoimmune disorders. This review highlights importance of the MRL model as a useful preparation in understanding the links between immune system and brain function.
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Affiliation(s)
- Boris Šakić
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
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Kapadia M, Bijelić D, Zhao H, Ma D, Stojanovich L, Milošević M, Andjus P, Šakić B. Effects of sustained i.c.v. infusion of lupus CSF and autoantibodies on behavioral phenotype and neuronal calcium signaling. Acta Neuropathol Commun 2017; 5:70. [PMID: 28882191 PMCID: PMC5590168 DOI: 10.1186/s40478-017-0473-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune disease that is often accompanied by brain atrophy and diverse neuropsychiatric manifestations of unknown origin. More recently, it was observed that cerebrospinal fluid (CSF) from patients and lupus-prone mice can be neurotoxic and that acute administration of specific brain-reactive autoantibodies (BRAs) can induce deficits in isolated behavioral tasks. Given the chronic and complex nature of CNS SLE, the current study examines broad behavioral performance and neuronal Ca2+ signaling in mice receiving a sustained infusion of cerebrospinal fluid (CSF) from CNS SLE patients and putative BRAs (anti-NR2A, anti-ribosomal P, and anti-α-tubulin). A 2-week intracerebroventricular (i.c.v.) infusion of CSF altered home-cage behavior and induced olfactory dysfunction, excessive immobility in the forced swim test, and perseveration in a learning task. Conversely, sustained administration of purified BRAs produced relatively mild, both inhibitory and stimulatory effects on olfaction, spatial learning/memory, and home-cage behavior. In vitro studies revealed that administration of some CSF samples induces a rapid influx of extracellular Ca2+ into murine neurons, an effect that could be partially mimicked with the commercial anti-NR2A antibody and blocked with selective N-methyl-D-aspartate (NMDA) receptor antagonists. The current findings confirm that the CSF from CNS SLE patients can be neuroactive and support the hypothesis that intrathecal BRAs induce synergistically diverse effects on all domains of behavior. In addition, anti-NMDA receptor antibodies may alter Ca2+ homeostasis of central neurons, thus accounting for excitotoxicity and contributing to the heterogeneity of psychiatric manifestations in CNS SLE and other autoantibody-related brain disorders.
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Gupta N, Ganpati A, Mandal S, Mathew J, Goel R, Mathew AJ, Nair A, Ramasamy P, Danda D. Mycophenolate mofetil and deflazacort combination in neuropsychiatric lupus: a decade of experience from a tertiary care teaching hospital in southern India. Clin Rheumatol 2017; 36:2273-2279. [DOI: 10.1007/s10067-017-3775-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 07/06/2017] [Accepted: 07/18/2017] [Indexed: 01/24/2023]
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Wang J, Yang C, Zhao Q, Zhu Z, Li Y, Yang P. Microglia activation induced by serum of SLE patients. J Neuroimmunol 2017; 310:135-142. [PMID: 28778438 DOI: 10.1016/j.jneuroim.2017.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 01/10/2023]
Abstract
To investigate the potential involvement of microglia in the neuropathology of systemic lupus erythematosus (SLE), we examined whether SLE patient sera could activate BV2 microglia in vitro. Exposure to SLE patient sera resulted in morphological changes in the microglia, an increase in MHC II and CD86 protein expression, and an obvious release of nitric oxide and proinflammatory cytokines. However, the SLE sera did not induce a specific change in the production of immunoregulatory cytokines. Inactivating complements or neutralizing proinflammatory cytokines in the SLE sera did not suppress microglial activation. Our results highlight the potential role of microglia in neuroinflammation in SLE patients.
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Affiliation(s)
- Jianing Wang
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Chunshu Yang
- Department of 1st Cancer Institute, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Qi Zhao
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Ziwei Zhu
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Yujia Li
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Pingting Yang
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China.
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Hanly JG. Avoiding diagnostic pitfalls in neuropsychiatric lupus: the importance of attribution. Lupus 2017; 26:497-503. [DOI: 10.1177/0961203317690244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuropsychiatric events in systemic lupus erythematosus patients may present a diagnostic and therapeutic challenge. Common and heterogeneous, their characterization and attribution to systemic lupus erythematosus and non-systemic lupus erythematosus is important and derived from clinical assessment, selection and interpretation of investigations. A standardized approach to assigning attribution has been used in recent studies. The current therapies are largely empiric, based upon known disease mechanisms and treatment of other serious organ disease in systemic lupus erythematosus. Further insight on the immunopathogenetic mechanisms and clinical outcome of neuropsychiatric systemic lupus erythematosus is required to inform the design and execution of therapeutic clinical trials.
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Affiliation(s)
- J G Hanly
- Division of Rheumatology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
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10
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A Case of "Refractory" Neuropsychiatric Lupus Responsive to Anticoagulation. Case Rep Neurol Med 2017; 2017:5726180. [PMID: 28251001 PMCID: PMC5303852 DOI: 10.1155/2017/5726180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Neuropsychiatric disorder is a severe complication in 14% to 75% of systemic lupus erythematosus (SLE) patients, which can result in significant morbidity. A 15-year-old female SLE patient with coexistence of dural sinus thrombosis and intracerebral hemorrhage resistant to two pulses of high dose of glucocorticoid was treated with anticoagulation of the low-molecular-weight [LMW] heparin subcutaneously followed by warfarin. The patient demonstrated a remarkable clinical response.
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Selmi C, Barin JG, Rose NR. Current trends in autoimmunity and the nervous system. J Autoimmun 2016; 75:20-29. [DOI: 10.1016/j.jaut.2016.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 08/06/2016] [Indexed: 01/17/2023]
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12
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Matsuda S, Yoshida S, Takeuchi T, Fujiki Y, Yoshikawa A, Makino S. Asymptomatic rheumatoid meningitis revealed by magnetic resonance imaging, followed by systemic rheumatic vasculitis: A case report and a review of the literature. Mod Rheumatol 2016; 29:370-376. [DOI: 10.1080/14397595.2016.1232333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shogo Matsuda
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Osaka, Japan
| | - Shuzo Yoshida
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Osaka, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Osaka, Japan
| | - Yohei Fujiki
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Osaka, Japan
| | - Ayaka Yoshikawa
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Osaka, Japan
| | - Shigeki Makino
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Osaka, Japan
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The diagnosis and clinical management of the neuropsychiatric manifestations of lupus. J Autoimmun 2016; 74:41-72. [PMID: 27427403 DOI: 10.1016/j.jaut.2016.06.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Abstract
Neuropsychiatric (NP) involvement in Systemic Lupus Erythematosus (SLE), can be a severe and troubling manifestation of the disease that heavily impacts patient's health, quality of life and disease outcome. It is one of the most complex expressions of SLE which can affect central, peripheral and autonomous nervous system. Complex interrelated pathogenetic mechanisms, including genetic factors, vasculopathy, vascular occlusion, neuroendocrine-immune imbalance, tissue and neuronal damage mediated by autoantibodies, inflammatory mediators, blood brain barrier dysfunction and direct neuronal cell death can be all involved. About NPSLE a number of issues are still matter of debate: from classification and burden of NPSLE to attribution and diagnosis. The role of neuroimaging and new methods of investigation still remain pivotal and rapidly evolving as well as is the increasing knowledge in the pathogenesis. Overall, two main pathogenetic pathways have been recognized yielding different clinical phenotypes: a predominant ischemic-vascular one involving large and small blood vessels, mediated by aPL, immune complexes and leuko-agglutination which it is manifested with more frequent focal NP clinical pictures and a predominantly inflammatory-neurotoxic one mediated by complement activation, increased permeability of the BBB, intrathecal migration of autoantibodies, local production of immune complexes and pro-inflammatory cytokines and other inflammatory mediators usually appearing as diffuse NP manifestations. In the attempt to depict a journey throughout NPSLE from diagnosis to a reasoned therapeutic approach, classification, epidemiology, attribution, risk factors, diagnostic challenges, neuroimaging techniques and pathogenesis will be considered in this narrative review based on the most relevant and recent published data.
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Kapadia M, Xu J, Sakic B. The water maze paradigm in experimental studies of chronic cognitive disorders: Theory, protocols, analysis, and inference. Neurosci Biobehav Rev 2016; 68:195-217. [PMID: 27229758 DOI: 10.1016/j.neubiorev.2016.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 02/07/2023]
Abstract
An instrumental step in assessing the validity of animal models of chronic cognitive disorders is to document disease-related deficits in learning/memory capacity. The water maze (WM) is a popular paradigm because of its low cost, relatively simple protocol and short procedure time. Despite being broadly accepted as a spatial learning task, inference of generalized, bona fide "cognitive" dysfunction can be challenging because task accomplishment is also reliant on non-cognitive processes. We review theoretical background, testing procedures, confounding factors, as well as approaches to data analysis and interpretation. We also describe an extended protocol that has proven useful in detecting early performance deficits in murine models of neuropsychiatric lupus and Alzheimer's disease. Lastly, we highlight the need for standardization of inferential criteria on "cognitive" dysfunction in experimental rodents and exclusion of preparations of a limited scientific merit. A deeper appreciation for the multifactorial nature of performance in WM may also help to reveal other deficits that herald the onset of neurodegenerative brain disorders.
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Affiliation(s)
- Minesh Kapadia
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Psychology Building Rm. 303, 1280 Main St., West Hamilton, Ontario L8S 4K1, Canada
| | - Josie Xu
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Psychology Building Rm. 303, 1280 Main St., West Hamilton, Ontario L8S 4K1, Canada
| | - Boris Sakic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Psychology Building Rm. 303, 1280 Main St., West Hamilton, Ontario L8S 4K1, Canada.
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15
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Rovira Á, Auger C, Rovira A. Other noninfectious inflammatory disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:425-446. [PMID: 27432677 DOI: 10.1016/b978-0-444-53485-9.00021-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Idiopathic inflammatory-demyelinating diseases (IIDDs) represent a broad spectrum of central nervous system (CNS) disorders, including monophasic, multiphasic, and progressive disorders that range from highly localized forms to multifocal or diffuse variants. In addition to the classic multiple sclerosis (MS) phenotypes, several MS variants have been described, which can be differentiated on the basis of severity, clinical course, and lesion distribution. Other forms of IIDD are now recognized as distinct entities and not MS variants, such as acute disseminated encephalomyelitis, and neuromyelitis optica spectrum disorders. The CNS can also be affected by a variety of inflammatory diseases. These include primary angiitis of the CNS (PACNS), a rare disorder specifically targeting the CNS vasculature, and various systemic conditions which, among other organs and systems, can also affect the CNS, such as systemic vasculitis and sarcoidosis. The diagnosis of PACNS is difficult, as this condition may be confused with reversible cerebral vasoconstriction syndrome (RCVS), a term comprising a group of conditions characterized by prolonged but reversible vasoconstriction of the cerebral arteries. Magnetic resonance imaging of the brain and spine is the radiologic technique of choice for diagnosing these disorders, and, together with the clinical and laboratory findings, enables a prompt and accurate diagnosis.
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Affiliation(s)
- Álex Rovira
- MR Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - Cristina Auger
- MR Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Rovira
- Corporació Sanitària Parc Taulí, CD-UDIAT, Sabadell, Spain
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Abstract
We present a succinct review of our approach to study the interactions between the DNA-reactive antibodies that cross-react with the GluN2A and GluN2B subunits of the N-methyl-D-aspartate receptor, denoted DNRABs, and their brain targets in subjects with neuropsychiatric systemic lupus erythematosus (NPSLE). We have analyzed the DNRAB-based brain symptomatology in mouse models of NPSLE by using an integrative neuroscience approach, which includes behavioral assessment coupled with electrophysiological studies of neural networks and synaptic connections in target brain regions, such as the CA1 region of the hippocampus. Our results suggest a framework for understanding the interactions between immune factors and neural networks.
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Affiliation(s)
- Patricio T Huerta
- Laboratory of Immune and Neural Networks, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.
- Department of Molecular Medicine, Hofstra North Shore LIJ Medical School, Hempstead, NY, USA.
| | - Elizabeth L Gibson
- Laboratory of Immune and Neural Networks, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Carson Rey
- Laboratory of Immune and Neural Networks, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Tomás S Huerta
- Laboratory of Immune and Neural Networks, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
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17
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Hanly JG. Attribution in the assessment of nervous system disease in SLE. Rheumatology (Oxford) 2014; 54:755-6. [PMID: 25480812 DOI: 10.1093/rheumatology/keu458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- John G Hanly
- Medicine, Division of Rheumatology and Department of Pathology, Dalhousie University, 1341 Summer Street, Halifax, Nova Scotia and Capital Health, Halifax, Nova Scotia, Canada Medicine, Division of Rheumatology and Department of Pathology, Dalhousie University, 1341 Summer Street, Halifax, Nova Scotia and Capital Health, Halifax, Nova Scotia, Canada
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Jeong HW, Her M, Bae JS, Kim SK, Lee SW, Kim HK, Kim D, Park N, Chung WT, Lee SY, Choe JY, Kim IJ. Brain MRI in neuropsychiatric lupus: associations with the 1999 ACR case definitions. Rheumatol Int 2014; 35:861-9. [DOI: 10.1007/s00296-014-3150-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
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Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: pathogenesis and biomarkers. Nat Rev Neurol 2014; 10:579-96. [DOI: 10.1038/nrneurol.2014.148] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Tamashiro LF, Oliveira RDR, Oliveira R, Frota ERC, Donadi EA, Del-Ben CM, Teixeira AL, Louzada-Junior P. Participation of the neutrophin brain-derived neurotrophic factor in neuropsychiatric systemic lupus erythematosus. Rheumatology (Oxford) 2014; 53:2182-90. [PMID: 24942492 DOI: 10.1093/rheumatology/keu251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Brain-derived neurotrophic factor (BDNF) is associated with the pathogenesis of several neuropsychiatric (NP) diseases, but there are few studies involving SLE. The aim of this study was to investigate whether plasma BDNF levels are associated with disease activity in SLE patients with severe NPSLE and non-NPSLE manifestations. METHODS We assessed 131 SLE patients and 24 randomly selected healthy individuals. SLE patients were evaluated in a cross-sectional study allocated according to the presence or not of NP manifestations and disease activity: (i) active NPSLE (n = 40), (ii) inactive NPSLE (n = 26), (iii) active SLE (n = 29) and (iv) inactive SLE (n = 36). In addition, NPSLE patients (n = 40) were evaluated before and after treatment. Disease activity was assessed according to the SLEDAI score. The plasma BDNF was measured by ELISA. RESULTS BDNF levels were increased in inactive NPSLE when compared with active SLE and controls (P < 0.0001). We observed similar findings in inactive SLE when compared with active SLE (P < 0.0001). In addition, we found an inverse correlation between plasma BDNF levels and the SLEDAI (r = -0.54, P < 0.0001) and a positive correlation with complement levels. We also observed an increase in BDNF levels in parallel with the improvement in NP symptoms. CONCLUSION Plasma BDNF level is increased in SLE patients and this increase is independent of the occurrence of NP manifestations. In addition, plasma BDNF levels increased with control of SLE activity, which points to the potential use of BDNF as a biomarker of response to treatment.
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Affiliation(s)
- Leticia Faleiros Tamashiro
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Renê D R Oliveira
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Oliveira
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Regina Comini Frota
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Eduardo Antonio Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio Lucio Teixeira
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Paulo Louzada-Junior
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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Calderón J, Flores P, Babul M, Aguirre JM, Slachevsky A, Padilla O, Scoriels L, Henríquez C, Cárcamo C, Bravo-Zehnder M, González A, Massardo L. Systemic lupus erythematosus impairs memory cognitive tests not affected by depression. Lupus 2014; 23:1042-53. [DOI: 10.1177/0961203314536247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Our aim was to assess the contribution of depression to cognitive impairment in patients with systemic lupus erythematosus (SLE). Methods Clinical features, education, age, and Hospital Anxiety and Depression Scale (HADS) were evaluated in 82 patients with SLE and 22 healthy controls, all Chilean women. The Cambridge Neuropsychological Test Automated Battery (CANTAB eclipseTM) assessing attention, spatial memory, and learning and executive function domains was applied. Cognitive deficit definition: a cut-off for definite impairment was defined as a score below -2 standard deviations in at least one outcome measure in two or more domains. ANCOVA with stepwise selection evaluated influences of health status (SLE or control), age, education, and HADS depression and anxiety scores on cognitive outcomes. To avoid overfitting, a shrinkage method was performed. Also, adjusted p-values for multiple comparisons were obtained. Results Cognitive deficit affected 16 (20%) patients, and no controls ( p = 0.039). Median HADS depression score in SLE patients was 6 (range 0–19) and in controls was 0 (0–19), p < 0.001). ANCOVA and shrinkage models showed that worse cognitive performance in sustained attention and spatial working memory tests was explained by the presence of SLE but not depression, whereas depression only affected a measure of executive function (I/ED Stages completed). Conclusion Depression has a limited role in cognitive impairment in SLE. Impairments in sustained attention and spatial working memory are distinctly influenced by yet-unknown disease-intrinsic factors.
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Affiliation(s)
- J Calderón
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - P Flores
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - M Babul
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - JM Aguirre
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - A Slachevsky
- Department of Neurological Sciences Oriente, Facultad de Medicina, Universidad de Chile, Chile
| | - O Padilla
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - L Scoriels
- Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Brazil
| | - C Henríquez
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - C Cárcamo
- Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - M Bravo-Zehnder
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - A González
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
- Center for Aging and Regeneration, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Massardo
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
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Streifler JY, Molad Y. Connective tissue disorders: systemic lupus erythematosus, Sjögren's syndrome, and scleroderma. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:463-473. [PMID: 24365313 DOI: 10.1016/b978-0-7020-4086-3.00030-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Connective tissue disorders are systemic, autoimmune, multiorgan diseases in which the central and peripheral nervous systems are frequently involved. The objective of this chapter is to describe the neurological manifestations of three of the most common systemic autoimmune disorders: systemic lupus erythematosus (SLE), scleroderma, and Sjögren's syndrome (SS). In SLE the neuropsychiatric manifestations involve mainly the central nervous system (CNS), including cognitive dysfunction, headache, psychosis and mood changes, seizures, cerebrovascular disease, and myelopathy. Peripheral nervous system (PNS) manifestations are less common and include polyneuropathies as well as mononeuropathies and acute inflammatory demyelinating polyneuropathy. Antiphospholipid syndrome (APLS) is relatively common and should be searched for whenever focal neurological symptoms occur. In scleroderma the PNS is more commonly involved; symptoms include polyneuropathies, entrapment neuropathies, and mononeuropathies (mostly cranial neuropathies or mononeuritis multiplex). Additionally autonomic involvement occurs and myopathies are relatively common. In SS the PNS is similarly involved with several types of polyneuropathies, mononeuropathies, and autonomic dysfunction. Also common are myelopathies and aseptic meningitides. These and other, less common manifestations, as well as the diagnostic procedures and the therapeutic approaches, will be dealt with in this chapter.
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Affiliation(s)
- Jonathan Y Streifler
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and Neurology Unit, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel.
| | - Yair Molad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and Rheumatology Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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23
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Abdul-Sattar AB, Goda T, Negm MG. Neuropsychiatric manifestations in a consecutive cohort of systemic lupus erythematosus; a single center study. Int J Rheum Dis 2013; 16:715-23. [DOI: 10.1111/1756-185x.12213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amal Bakry Abdul-Sattar
- Department of Rheumatology and Rehabilitation; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Tarek Goda
- Department of Neurology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Mohamed G. Negm
- Department of Psychiatry; Faculty of medicine; Zagazig University; Zagazig Egypt
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Louthrenoo O, Krairojananan J, Chartapisak W, Opastirakul S. Psychosocial functioning of children with systemic lupus erythematosus. J Paediatr Child Health 2012; 48:1091-4. [PMID: 22735025 DOI: 10.1111/j.1440-1754.2012.02499.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS Systemic lupus erythematosus (SLE) is a chronic illness in children. Involvement of multiple systems; the chronicity, as well as the treatment, has had great impact on children and their families. The objective of this study was to assess emotional and behavioural problems in childhood lupus during disease remission. METHODS Children with SLE and healthy controls, aged 8-15 years, were studied. Disease remission was confirmed by using the SLE Disease Activity Index (SLEDAI). The Children's Depression Inventory (CDI) and Multidimensional Anxiety Scale for Children (MASC) were rated by the children themselves. The Child Behaviour Checklist was completed by their parents. RESULTS The sample included 40 children with SLE and 40 controls. Their mean age was 12.9 ± 2.1 and 12.1 ± 1.8 years in the SLE and control groups, respectively. The average duration of the disease was 2.6 years. The SLEDAI in the SLE group ranged from 0-1, indicating inactive disease. The mean CDI scores were 8.9 and 10.9 in lupus children and controls, respectively. The mean MASC score was 44.7 in children with SLE and 48.4 in controls. The internalizing, externalizing and total behavioural scores were not significantly different in both groups (9.0 vs. 10.6; 6.6 vs. 8.1; 27.3 vs. 32.5). Only the social competence score was lower in children with SLE (P= 0.03). CONCLUSIONS SLE is a multi-system involvement disease with wide ranging effects on children's physical and psychosocial functioning. However, children with SLE, during inactive disease, were not found to be at increased risk of psychosocial dysfunctions.
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Affiliation(s)
- Orawan Louthrenoo
- Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Thailand.
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Marcinko K, Parsons T, Lerch JP, Sled JG, Sakic B. Effects of prolonged treatment with memantine in the MRL model of CNS lupus. ACTA ACUST UNITED AC 2012; 3:116-128. [PMID: 23554849 DOI: 10.1111/j.1759-1961.2012.00032.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Neuropsychiatric manifestations and brain atrophy of unknown etiology are common and severe complications of systemic lupus erythematosus (SLE). An autoantibody that binds to N-methyl-D-aspartate (NMDA) receptor NR2 has been proposed as a key factor in the etiology of central nervous system (CNS) SLE. This hypothesis was supported by evidence suggesting memantine (MEM), an uncompetitive NMDA receptor antagonist, prevents behavioral dysfunction and brain pathology in healthy mice immunized with a peptide similar to an epitope on the NR2 receptor. Given that SLE is a chronic condition, we presently examine the effects of MEM in MRL/lpr mice, which develop behavioral deficits alongside SLE-like disease. METHODS A broad behavioral battery and 7-Tesla MRI were used to examine whether prolonged treatment with MEM (~25 mg/kg b.w. in drinking water) prevents CNS involvement in this spontaneous model of SLE. RESULTS Although MEM increased novel object exploration in MRL/lpr mice, it did not show other beneficial, substrain-specific effects. Conversely, MEM was detrimental to spontaneous activity in control MRL +/+ mice and had a negative effect on body mass gain. Similarly, MRI revealed comparable increases in the volume of periventricular structures in MEM-treated groups. CONCLUSIONS Sustained exposure to MEM affects body growth, brain morphology, and behavior primarily by pharmacological, and not autoimmunity-dependant mechanisms. Substrain-specific improvement in exploratory behavior of MEM-treated MRL/lpr mice may indicate that the NMDA system is merely a constituent of a complex pathogenenic cascade. However, it was evident that chronic administration of MEM is unable to completely prevent the development of a CNS SLE-like syndrome.
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Affiliation(s)
- Katarina Marcinko
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton
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Kapadia M, Stanojcic M, Earls AM, Pulapaka S, Lee J, Sakic B. Altered olfactory function in the MRL model of CNS lupus. Behav Brain Res 2012; 234:303-11. [PMID: 22796602 DOI: 10.1016/j.bbr.2012.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/02/2012] [Accepted: 07/06/2012] [Indexed: 12/22/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that damages several bodily systems, including the CNS. Brain atrophy and diverse neuropsychiatric manifestations are common and serious complications of SLE. Recently, it has been reported that many patients with CNS involvement also present with olfactory deficits of unknown etiology. Similar to CNS SLE, spontaneous development of lupus-like disease in MRL/lpr mice is accompanied by neurodegeneration in periventricular regions and a constellation of behavioral deficits dependent on olfaction. To test the possibility that olfactory dysfunction also occurs in autoimmune mice, we presently examine odor-guided behaviors using a battery of paradigms. Indeed, lupus-prone males spent less time exploring unfamiliar conspecifics and demonstrated age-dependant performance deficits when exposed to low concentrations of attractant and repellant odors. The emergence of olfactory changes was associated with a skewed distribution of DCX(+) cells in the proximal portion of the rostral migratory stream (RMS). The present results are consistent with the hypothesis that the onset of a SLE-like condition affects periventricular regions, including the RMS, as evidenced by disrupted migration of neuronal precursor cells toward the olfactory bulb. If so, ensuing hyposmia and/or olfactory memory deficit may contribute to altered performance in other behavioral tasks and reflect a prodrome of brain damage induced by chronic autoimmune disease.
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Affiliation(s)
- Minesh Kapadia
- The Brain-Body Institute, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
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Nishimura K, Omori M, Sato E, Katsumata Y, Gono T, Kawaguchi Y, Harigai M, Yamanaka H, Ishigooka J. Risperidone in the treatment of corticosteroid-induced mood disorders, manic/mixed episodes, in systemic lupus erythematosus: a case series. PSYCHOSOMATICS 2012; 53:289-293. [PMID: 22284421 DOI: 10.1016/j.psym.2011.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 05/31/2023]
Affiliation(s)
- Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
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Labrador-Horrillo M, Martinez-Valle F, Gallardo E, Rojas-Garcia R, Ordi-Ros J, Vilardell M. Anti-ganglioside antibodies in patients with systemic lupus erythematosus and neurological manifestations. Lupus 2012; 21:611-5. [PMID: 22323340 DOI: 10.1177/0961203312436856] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Anti-ganglioside antibodies (AGA) have been associated with several peripheral neuropathies, such as Miller-Fisher syndrome, Guillain-Barré syndrome and multifocal motor neuropathy. They have also been studied in patients with systemic lupus erythematosus (SLE), focusing on neuropsychiatric manifestations and peripheral neuropathy, but the results are contradictory. OBJECTIVE To study the presence of AGA in a large cohort of patients with SLE and neuropsychiatric manifestations. PATIENTS AND METHODS Serum from 65 consecutive patients with SLE and neuropsychiatric manifestations, collected from 1985 to 2009, was tested for the presence of AGA antibodies (GM1, GM2, GM3, asialo-GM1 GD1a, GD1b, GD3, GT1b, GQ1b) using a standard enzyme-linked immunosorbent assay ELISA test (INCAT 1999) and thin layer chromatography (TLC). RESULTS Positive results for asialo-GM1 (IgM) were found in 10 patients, 6 were positive for asialo-GM1 (IgM and IgG), and 4 were positive for other AGA such as GM1, GM2, GM3, GD1b, GT1b, GD3, (mainly IgM). CONCLUSIONS Clinical and statistical studies showed no correlation between AGA and neuropsychiatric manifestations of SLE. Although some patients showed reactivity to AGA, these antibodies are not a useful marker of neuropsychiatric manifestations in SLE patients.
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Affiliation(s)
- M Labrador-Horrillo
- Internal Medicine Department, Hospital Vall d'Hebron, UAB, Barcelona, Spain.
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Psychiatric disorders in juvenile systemic lupus erythematosus. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000407897.01230.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sakić B. The MRL model: an invaluable tool in studies of autoimmunity-brain interactions. Methods Mol Biol 2012; 934:277-99. [PMID: 22933151 DOI: 10.1007/978-1-62703-071-7_14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The link between systemic autoimmunity, brain pathology, and aberrant behavior is still largely unexplored field of biomedical science. Accumulating evidence points to causal relationships between immune factors, neurodegeneration, and neuropsychiatric manifestations. By documenting autoimmunity-associated neuronal degeneration and cytotoxicity of the cerebrospinal fluid from disease-affected subjects, the murine MRL model had shown high validity in revealing principal pathogenic circuits. In addition, unlike any other autoimmune strain, MRL mice produce antibodies commonly found in patients suffering from lupus and other autoimmune disorders. This review highlights importance of the MRL model as an indispensible preparation in understanding the links between immune system and brain function.
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Affiliation(s)
- Boris Sakić
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
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31
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Kapadia M, Sakic B. Autoimmune and inflammatory mechanisms of CNS damage. Prog Neurobiol 2011; 95:301-33. [DOI: 10.1016/j.pneurobio.2011.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 12/13/2022]
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Hanly JG, Urowitz MB, Su L, Bae SC, Gordon C, Clarke A, Bernatsky S, Vasudevan A, Isenberg D, Rahman A, Wallace DJ, Fortin PR, Gladman D, Romero-Diaz J, Romero-Dirz J, Sanchez-Guerrero J, Dooley MA, Bruce I, Steinsson K, Khamashta M, Manzi S, Ramsey-Goldman R, Sturfelt G, Nived O, van Vollenhoven R, Ramos-Casals M, Aranow C, Mackay M, Kalunian K, Alarcón GS, Fessler BJ, Ruiz-Irastorza G, Petri M, Lim S, Kamen D, Peschken C, Farewell V, Thompson K, Theriault C, Merrill JT. Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus. Ann Rheum Dis 2011; 70:1726-32. [PMID: 21893582 PMCID: PMC4664555 DOI: 10.1136/ard.2010.148502] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Neuropsychiatric events occur unpredictably in systemic lupus erythematosus (SLE) and most biomarker associations remain to be prospectively validated. This study examined a disease inception cohort of 1047 SLE patients to determine which autoantibodies at enrolment predicted subsequent neuropsychiatric events. METHODS Patients with a recent SLE diagnosis were assessed prospectively for up to 10 years for neuropsychiatric events using the American College of Rheumatology case definitions. Decision rules of graded stringency determined whether neuropsychiatric events were attributable to SLE. Associations between the first neuropsychiatric event and baseline autoantibodies (lupus anticoagulant (LA), anticardiolipin, anti-β(2) glycoprotein-I, anti-ribosomal P and anti-NR2 glutamate receptor) were tested by Cox proportional hazards regression. RESULTS Disease duration at enrolment was 5.4 ± 4.2 months, follow-up was 3.6 ± 2.6 years. Patients were 89.1% female with mean (±SD) age 35.2 ± 13.7 years. 495/1047 (47.3%) developed one or more neuropsychiatric event (total 917 events). Neuropsychiatric events attributed to SLE were 15.4% (model A) and 28.2% (model B). At enrolment 21.9% of patients had LA, 13.4% anticardiolipin, 15.1% anti-β(2) glycoprotein-I, 9.2% anti-ribosomal P and 13.7% anti-NR2 antibodies. LA at baseline was associated with subsequent intracranial thrombosis (total n=22) attributed to SLE (model B) (HR 2.54, 95% CI 1.08 to 5.94). Anti-ribosomal P antibody was associated with subsequent psychosis (total n=14) attributed to SLE (model B) (HR 3.92, 95% CI 1.23 to 12.5, p=0.02). Other autoantibodies did not predict neuropsychiatric events. CONCLUSION In a prospective study of 1047 recently diagnosed SLE patients, LA and anti-ribosomal P antibodies are associated with an increased future risk of intracranial thrombosis and lupus psychosis, respectively.
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Affiliation(s)
- J G Hanly
- Department of Medicine, Division of Rheumatology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
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Postal M, Costallat LTL, Appenzeller S. Neuropsychiatric manifestations in systemic lupus erythematosus: epidemiology, pathophysiology and management. CNS Drugs 2011; 25:721-36. [PMID: 21870886 DOI: 10.2165/11591670-000000000-00000] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease with CNS involvement occurring in up to 75% of patients. However, the frequency of neuropsychiatric manifestations in SLE studies varies widely, depending on the type of manifestations included and the method used for evaluation. CNS involvement may be considered primary if directly related to SLE activity in the CNS or secondary when related to treatment, infections, metabolic abnormalities or other systemic manifestations such as uraemia and hypertension. The pathogenesis of neuropsychiatric SLE is as yet unknown, though numerous autoantibodies and cytokines have been suggested as possible mediators. However, independent of the aetiology of the insult, the final common pathway in neuropsychiatric SLE is the involvement of the cerebral microvasculature. The diagnosis of primary CNS involvement by SLE is often difficult, as both focal and diffuse manifestations may occur and there is no gold standard for diagnosis. A high index of clinical suspicion, in addition to laboratory and neuroimaging findings may support the diagnosis. Treatment is mostly empirical, although one randomized controlled trial has shown that cyclophosphamide in addition to methylprednisolone is superior to methylprednisolone alone in severe neuropsychiatric SLE.
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Affiliation(s)
- Mariana Postal
- Department of Medicine, Rheumatology Unit, State University of Campinas, Brazil
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Shehata GA, Elserogy YM, Ahmad HEK, Abdel-Kareem MI, Al-Kabeer AM, Rayan MM, El-Baky MEA. Multimodal neurophysiological and psychometric evaluation among patients with systemic lupus erythematosus. Int J Gen Med 2011; 4:325-32. [PMID: 21674025 PMCID: PMC3108200 DOI: 10.2147/ijgm.s16492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine some of the neuropsychiatric manifestations of systemic lupus erythematosus (SLE) by applying multimodal neurophysiological and psychometric studies. PATIENTS AND METHODS Twenty-six SLE patients were evaluated for neurological and psychiatric disorders and compared with 26 healthy controls matched for age, sex, education, and social class. The severity of SLE disease was assessed. Each subject was subjected to the following examinations: laboratory, neurophysiology, magnetic resonance imaging of the brain, transcranial duplex, Modified Mini-mental State Examination, Cognitive Assessment Scale Inventory, Hamilton Depression Scale, and Hamilton Anxiety Scale. RESULTS The mean age of subjects was 25.9 ± 8.9 years. The most prevalent neurological manifestations were (in order of frequency) anxiety in 17 cases (65.4%), depression in 15 cases (57.7%), headache in 10 cases (38.5%), peripheral neuropathy in 7 cases (26.9%), seizures in 6 cases (23.1%), psychosis in 5 cases (19.2%), dementia in 4 cases (15.4%), radiculopathy in 4 cases (15.4%), myositis in 3 cases (11.5%), and stroke in 2 cases (7.7%). There was a significant affection in amplitude of the ulnar nerve, cognitive function impairment, and electroencephalography changes. There was a significant increased mean velocity and decreased Pulsatility Index of the most studied intracranial vessels in the patients. CONCLUSION The use of multimodal neurophysiological, transcranial duplex, and psychometric scales increases the sensitivity for detecting nervous system involvement.
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Treatment of non-renal lupus. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Jarpa E, Babul M, Calderón J, González M, Martínez ME, Bravo-Zehnder M, Henríquez C, Jacobelli S, González A, Massardo L. Common mental disorders and psychological distress in systemic lupus erythematosus are not associated with disease activity. Lupus 2010; 20:58-66. [DOI: 10.1177/0961203310381773] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychiatric diagnosis in patients with systemic lupus erythematosus (SLE) is controversial: variations have been reported in frequency, diagnostic assays, associations with disease activity, autoantibodies, and contributing social factors. Eighty-three consecutive non-selected Chilean patients with SLE were evaluated for: (i) 26 common mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the Mini-International Neuropsychiatric Interview (MINI-plus); (ii) psychological suffering measured by Hospital Anxiety and Depression Scale (HADS); (iii) ACR 1999 neuropsychiatric (NP)SLE criteria; (iv) SLE disease activity (SLEDAI-2K); (v) cumulative damage (SLICC/ACR); and (vi) anti-ribosomal P antibodies by enzyme-linked immunoassay and immunoblot. Psychiatric diagnoses occurred in 44.6% of patients; the most frequent (21.7%) was major depressive episode (MDE). No association with lupus activity was observed in patients with a DSM-IV diagnosis or MDE or psychological suffering. ACR 1999 NPSLE criteria were present in 42.2% of patients, the majority corresponding to mood (28.9%) or anxiety disorders (15.6%). Suicidal risk was present in 9.6% of patients. Anti-ribosomal P antibodies (13.3%) were not associated with DSM-IV diagnosis. Severe psychiatric disorders in SLE are common and not associated with disease activity.
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Affiliation(s)
- E Jarpa
- Department of Clinical Immunology and Rheumatology
| | - M Babul
- Department of Psychiatry, School of Medicine
| | - J Calderón
- Department of Psychiatry, School of Medicine
| | - M González
- Department of Psychiatry, School of Medicine
| | - ME Martínez
- Department of Clinical Immunology and Rheumatology
| | - M Bravo-Zehnder
- Department of Clinical Immunology and Rheumatology
- Center of Cell Regulation and Pathology, Center of Aging and Regeneration, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile
- Millennium Institute for Fundamental and Applied Biology, Santiago, Chile
| | - C Henríquez
- Department of Clinical Immunology and Rheumatology
| | - S Jacobelli
- Department of Clinical Immunology and Rheumatology
| | - A González
- Department of Clinical Immunology and Rheumatology
- Center of Cell Regulation and Pathology, Center of Aging and Regeneration, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile
- Millennium Institute for Fundamental and Applied Biology, Santiago, Chile
| | - L Massardo
- Department of Clinical Immunology and Rheumatology
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Faust TW, Chang EH, Kowal C, Berlin R, Gazaryan IG, Bertini E, Zhang J, Sanchez-Guerrero J, Fragoso-Loyo HE, Volpe BT, Diamond B, Huerta PT. Neurotoxic lupus autoantibodies alter brain function through two distinct mechanisms. Proc Natl Acad Sci U S A 2010; 107:18569-74. [PMID: 20921396 PMCID: PMC2972998 DOI: 10.1073/pnas.1006980107] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Damaging interactions between antibodies and brain antigenic targets may be responsible for an expanding range of neurological disorders. In the case of systemic lupus erythematosus (SLE), patients generate autoantibodies (AAbs) that frequently bind dsDNA. Although some symptoms of SLE may arise from direct reactivity to dsDNA, much of the AAb-mediated damage originates from cross-reactivity with other antigens. We have studied lupus AAbs that bind dsDNA and cross-react with the NR2A and NR2B subunits of the NMDA receptor (NMDAR). In adult mouse models, when the blood-brain barrier is compromised, these NMDAR-reactive AAbs access the brain and elicit neuronal death with ensuing cognitive dysfunction and emotional disturbance. The cellular mechanisms that underlie these deleterious effects remain incompletely understood. Here, we show that, at low concentration, the NMDAR-reactive AAbs are positive modulators of receptor function that increase the size of NMDAR-mediated excitatory postsynaptic potentials, whereas at high concentration, the AAbs promote excitotoxicity through enhanced mitochondrial permeability transition. Other synaptic receptors are completely unaffected by the AAbs. NMDAR activation is required for producing both the synaptic and the mitochondrial effects. Our study thus reveals the mechanisms by which NMDAR-reactive AAbs trigger graded cellular alterations, which are likely to be responsible for the transient and permanent neuropsychiatric symptoms observed in patients with SLE. Our study also provides a model in which local AAb concentration determines the exact nature of the cellular response.
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Affiliation(s)
- Thomas W. Faust
- Burke Cornell Medical Research Institute, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, White Plains, NY 10605
| | - Eric H. Chang
- Burke Cornell Medical Research Institute, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, White Plains, NY 10605
| | - Czeslawa Kowal
- Autoimmune and Musculoskeletal Disease Center, Feinstein Institute for Medical Research, Manhasset, NY 11030; and
| | - RoseAnn Berlin
- Burke Cornell Medical Research Institute, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, White Plains, NY 10605
| | - Irina G. Gazaryan
- Burke Cornell Medical Research Institute, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, White Plains, NY 10605
| | - Eva Bertini
- Autoimmune and Musculoskeletal Disease Center, Feinstein Institute for Medical Research, Manhasset, NY 11030; and
| | - Jie Zhang
- Autoimmune and Musculoskeletal Disease Center, Feinstein Institute for Medical Research, Manhasset, NY 11030; and
| | - Jorge Sanchez-Guerrero
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México
| | - Hilda E. Fragoso-Loyo
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México
| | - Bruce T. Volpe
- Burke Cornell Medical Research Institute, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, White Plains, NY 10605
| | - Betty Diamond
- Autoimmune and Musculoskeletal Disease Center, Feinstein Institute for Medical Research, Manhasset, NY 11030; and
| | - Patricio T. Huerta
- Burke Cornell Medical Research Institute, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, White Plains, NY 10605
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Shehata GA, Abdel-Kareem MI, Yassin AEN, El Adl AHR. Subclinical cerebrovascular cognitive function, and mood changes in patients with systemic lupus erythematosus. Open Access Rheumatol 2010; 2:17-25. [PMID: 27789993 PMCID: PMC5074773 DOI: 10.2147/oarrr.s9711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of neuropsychiatric disorders, cerebral atherosclerosis in patients with systemic lupus erythematosus (SLE) and explore the relation between transcranial duplex findings of different intracranial vessels with neuropsychiatric affect, and Systemic lupus erythematosus disease activity index (SLEDAI). METHODS Twenty-six consecutive SLE patients were evaluated for neurological and psychiatric disorders. Another 26 subjects matched with respect to age, sex, education, and socioeconomic status formed the control group. SLE disease activity was assessed by the SLEDAI. For each participant, a complete medical history was obtained and clinical, laboratory, and neurophysiological examinations, magnetic resonance imaging of the brain, transcranial duplex for intracranial vessels, and psychometric evaluations were performed. For the psychometric evaluation, we used the Modified Mini-mental State Examination and Cognitive Assessment Scale Inventory to assess cognitive function, and Hamilton Depression Rating Scale and Hamilton Anxiety Scale to assess symptoms of depression and anxiety. RESULTS Anxiety in 65.4% is the most prevalent manifestation followed by depression in 57.7%, headache in 38.5%, peripheral neuropathy in 26.9%, seizures in 23.1%, psychosis in 19.2%, radiculopathy and dementia in 15.4% for each, myositis in 11.5%, and stroke in 7.7%. There was a significant increased mean velocity and decreased pulsatility index of most studied intracranial vessels in both patient groups than in the control group. There was significant negative correlation between SLEDAI and transcranial Doppler findings in the pulsatility index of medial circumflex artery and procoagulant activity. CONCLUSION Neurological disorders, cognitive impairment, depression, anxiety, psychosis and cerebrovascular changes detected by transcranial Doppler ultrasound are common in SLE.
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Affiliation(s)
- Ghaydaa A Shehata
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Abd ellah N Yassin
- Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdel Hamid R El Adl
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disorder, with a heterogeneous presentation. Disease severity is wide ranging, with most suffering milder forms; however, it is potentially fatal depending on organ involvement. The disorder was recognized as early as the Middle Ages, with the 12th-century physician Rogerius being the first to apply the term lupus to the classic malar rash, and in 1872, Moric Kaposi first recognized the systemic nature of the disease. Perioperatively, SLE can present major challenges to the anesthesiologist because of accrued organ damage, coagulation defects, and complex management regimes. In this article I highlight adult SLE manifestations and treatments pertinent to the anesthesiologist and discuss perioperative management of these complex patients.
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Huang HC, Liu CM, Liu CC. Psychiatric manifestations in systemic lupus erythematosus mimic psychotic prodrome: a case report. Gen Hosp Psychiatry 2010; 32:e3-4. [PMID: 20302983 DOI: 10.1016/j.genhosppsych.2009.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 03/25/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
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Abstract
This article reviews the epidemiology of autoimmune conditions in schizophrenia, symptom manifestations of autoimmune conditions resembling schizophrenia, and the immunological changes observed in schizophrenia; and reflects on their associations with neurodevelopment, neurodegeneration, clinical course, and management of schizophrenia.
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Sakic B. A novel experimental approach in treating central nervous system lupus: Kudos and Kicks. ACTA ACUST UNITED AC 2009; 60:3531-3. [DOI: 10.1002/art.25016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Williams S, Sakic B, Hoffman SA. Circulating brain-reactive autoantibodies and behavioral deficits in the MRL model of CNS lupus. J Neuroimmunol 2009; 218:73-82. [PMID: 19919882 DOI: 10.1016/j.jneuroim.2009.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/16/2009] [Accepted: 10/13/2009] [Indexed: 12/25/2022]
Abstract
Brain-reactive autoantibodies (BRAA) are hypothesized to play a role in the neuropsychiatric manifestations that accompany systemic lupus erythematosus (SLE). The present study tests the proposed relation between circulating BRAA and behavioral deficits in lupus-prone MRL/lpr mice. Two age-matched cohorts born at different times were used to test the relationship in the context of altered disease severity. Significant correlations between autoimmunity and behavior were detected in both cohorts. These results are the first to report correlations between behavior and autoantibodies to integral membrane proteins of brain, supporting the hypothesis that BRAA contribute to the behavioral dysfunction seen in lupus.
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Affiliation(s)
- S Williams
- Neuroimmunology Labs, School of Life Sciences, Arizona State University, Tempe, AZ 85287-4501 USA
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Appenzeller S, Veilleux M, Clarke A. Third cranial nerve palsy or pseudo 3rd nerve palsy of myasthenia gravis? A challenging diagnosis in systemic lupus erythematosus. Lupus 2009; 18:836-40. [PMID: 19578109 DOI: 10.1177/0961203308101546] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diplopia is frequently encountered in neurological practice and may occur as part of the clinical spectrum of 3rd cranial nerve palsy. Correct localization of the underlying problem is the first step in making an accurate diagnosis. Pathologies affecting the supranuclear structures, cranial nerves and nuclei, extraocular muscles and the neuromuscular junction may cause or simulate 3rd nerve palsy. We report a case of a patient with longstanding quiescent SLE who presented with sudden onset of diplopia and discuss possible aetiologies including ischemia, demyelination, neuromuscular conditions and medication-induced.
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Affiliation(s)
- S Appenzeller
- Division of Clinical Immunology/Allergy, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Appenzeller S, Cendes F, Costallat LTL. Cognitive impairment and employment status in systemic lupus erythematosus: A prospective longitudinal study. ACTA ACUST UNITED AC 2009; 61:680-7. [DOI: 10.1002/art.24346] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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46
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Zhu TY, Tam LS, Lee VWY, Lee KK, Li EK. Systemic lupus erythematosus with neuropsychiatric manifestation incurs high disease costs: a cost-of-illness study in Hong Kong. Rheumatology (Oxford) 2009; 48:564-8. [PMID: 19269959 DOI: 10.1093/rheumatology/kep031] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the direct and indirect costs of SLE in Hong Kong, and to ascertain the relationship between neuropsychiatric SLE (NPSLE) and disease costs. METHODS A retrospective, cross-sectional, non-randomized cost-of-illness study was performed in a tertiary rheumatology specialty centre in Hong Kong. Participants completed questionnaires on sociodemographics, employment status and out-of-pocket expenses. Healthcare resources consumption was recorded by chart review. The occurrence of NPSLE since onset of SLE was determined using the 1999 ACR nomenclature and standard definitions. Mann-Whitney U-test was used to compare disease costs between patients with and without NPSLE. Multiple linear regression was used to determine the predictors of the costs. RESULTS Three hundred and six Chinese patients were recruited, with a mean age of 41 years and mean disease duration of 9.6 years. A total of 108 NPSLE events were recorded by 83 patients. The most common manifestations were seizure and cardiovascular disease. The mean annual total costs were USD 13,307 per patient. The direct costs dominated the total costs, and the costs of inpatient care contributed 52% of the direct costs. Patients with NPSLE incurred significantly higher direct and indirect costs compared with those without NPSLE. The number of NPSLE events was an independent explanatory variable associated with both direct and indirect costs. CONCLUSION The economic impact of SLE in Hong Kong is considerable and patients with NPSLE incur higher disease costs compared with those without NPSLE. Improvement in prevention of end-organ damage, especially neuropsychiatric manifestation, may reduce costs of SLE patients.
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Affiliation(s)
- Tracy Y Zhu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
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Breda L, Nozzi M, De Sanctis S, Chiarelli F. Laboratory tests in the diagnosis and follow-up of pediatric rheumatic diseases: an update. Semin Arthritis Rheum 2009; 40:53-72. [PMID: 19246077 DOI: 10.1016/j.semarthrit.2008.12.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 12/03/2008] [Accepted: 12/15/2008] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We reviewed the literature to evaluate the role of common laboratory tests and to examine the recent progress in the laboratory diagnosis of pediatric rheumatic diseases. METHODS We used the PubMed database (1950-2008) to search for the keywords "laboratory," "erythrocyte sedimentation rate" (ESR), "C-reactive protein" (CRP), "blood cytology," "procalcitonin" (PCT), "complement system," "ferritin," "antistreptolysin O titer" (ASO), "autoantibodies," "genetic studies," in conjunction with "rheumatic disease in children" and "pediatric autoimmune diseases." All relevant original and review articles in English were reviewed as well as textbooks of pediatric rheumatology. RESULTS Laboratory tests (ESR, CRP, blood cytology, complement system, ferritin, ASO titer) play an important role in confirming a diagnosis and in the follow-up of rheumatic diseases in the pediatric age group. The ESR is probably the most widely measured index of the acute phase response. Measurement of CRP is very useful in the rapid diagnosis of infection as a progressive increase can be shown in the first 48 hours. Also, the subsequent fall in serum CRP concentration on resolution of inflammation is useful for monitoring the efficacy of treatment. In chronic diseases, a combination of CRP and ESR may provide the most useful information. Cytopenia and different forms of anemia can be encountered in many rheumatic diseases: they can be related to disease activity or to therapeutic side effects. Determination of complement levels (C3 and/or C4) is useful in the follow-up of systemic lupus erythematosus (SLE) and membranoproliferative glomerulonephritis. Ferritin is a laboratory hallmark of primary and secondary hemophagocytic lymphohistiocytosis. ASO titer should be obtained to confirm a diagnosis of acute rheumatic fever; other important antibody markers of streptococcal infection include antihyaluronidase, antideoxyribonuclease B, and antistreptokinase antibodies. We also found that, in the pediatric age, the main indication for synovial fluid analysis is suspected joint infection. Antinuclear antibodies, anti-Smith antigen, and anti-double-stranded DNA antibodies are important in the diagnosis of SLE, are useful prognostic markers, and facilitate clinical and treatment follow-up. Anti-SSA/Ro and anti-SSB/La antibodies are associated with Sjögren's syndrome and congenital heart block, while the anti-U1 small nuclear ribonucleoprotein antibodies show high specificity for mixed connective tissue disease. Repetitive spontaneous abortions, thrombocytopenia, and many types of venous or arterial thrombosis are associated with antiphospholipid antibodies. The presence of cytoplasmic antineutrophil antibodies is essential in the diagnosis of Wegener granulomatosis. The discovery of underlying single causative gene defects led to the identification of several autoinflammatory diseases, a group of genetic disorders characterized by recurrent attacks of inflammation (hereditary periodic fever syndromes). These include familial Mediterranean fever due to mutations in the Mediterranean fever (MEFV) gene, hyperimmunoglobulinemia D syndrome due to mutations in the MK gene for mevalonate kinase, cryopyrinopathies such as Muckle-Wells syndrome or neonatal-onset multisystemic inflammatory disease (neonatal-onset multisystemic inflammatory disease or chronic infantile neurological cutaneous and articular (CINCA)) associated with cold-induced autoinflammatory syndrome 1 gene mutations, and tumor necrosis factor receptor-associated periodic syndrome due to mutation of TNF receptor I gene. CONCLUSIONS Laboratory investigations play an important role in the diagnosis and follow-up of inflammatory rheumatic diseases in children. A good history and a complete physical examination are the best screening tests. Routine laboratory tests are useful to confirm a suspected diagnosis, to assess disease activity, and to measure the response and toxicity to treatment. Only a few tests represent diagnostic criteria such as antinuclear antibodies and anti-double-stranded DNA in SLE or cytoplasmic antineutrophil cytoplasmic autoantibodies in Wegener's granulomatosis. Recent advances in molecular genetics have impacted diagnosis, pathogenesis, and treatment in genetic fever syndromes.
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Affiliation(s)
- Luciana Breda
- Department of Pediatrics, Reumathology Unit, University of Chieti, Chieti, Italy.
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Santer DM, Yoshio T, Minota S, Möller T, Elkon KB. Potent induction of IFN-alpha and chemokines by autoantibodies in the cerebrospinal fluid of patients with neuropsychiatric lupus. THE JOURNAL OF IMMUNOLOGY 2009; 182:1192-201. [PMID: 19124763 DOI: 10.4049/jimmunol.182.2.1192] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Neuropsychiatric disease in systemic lupus erythematosus (NPSLE) is a poorly understood, but potentially fatal, disease manifestation. A pathogenetic role for autoantibodies is suspected, but the mechanism is unclear. Since immune complexes in SLE can stimulate IFN-alpha and there is strong evidence in humans and in mice that IFN-alpha can cause neuropsychiatric manifestations, we asked whether NPSLE patient serum and/or cerebrospinal fluid (CSF) contain abnormally high IFN-alpha-inducing activity. In a bioassay containing plasmacytoid dendritic cells and a source of Ag, NPSLE CSF induced significantly higher IFN-alpha compared with CSF from patients with multiple sclerosis or other autoimmune disease controls. When normalized for IgG concentration, NPSLE CSF was 800-fold more potent at inducing IFN-alpha compared with paired serum due to inhibitors present in serum. Analysis of Ig-deficient patient serum, depletion of IgG from normal serum, as well as addition of purified IgG to NPSLE CSF and serum in the bioassays revealed that one inhibitor was contained within the IgG fraction itself. In addition to IFN-alpha, immune complexes formed by CSF autoantibodies produced significantly increased levels of IFN-gamma-inducible protein 10 (IP-10/CXCL), IL-8, and MCP-1, all of which have been reported to be elevated in CSF from NPSLE patients. Taken together, these findings are consistent with a two-step model of NPSLE whereby CSF autoantibodies bind to Ags released by neurocytotoxic Abs or other brain cell injury, and the resulting immune complexes stimulate IFN-alpha and proinflammatory cytokines and chemokines.
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Affiliation(s)
- Deanna M Santer
- Department of Immunology, University of Washington, Seattle, WA 98195, USA
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Affiliation(s)
- JG Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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50
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George-Chandy A, Trysberg E, Eriksson K. Raised intrathecal levels of APRIL and BAFF in patients with systemic lupus erythematosus: relationship to neuropsychiatric symptoms. Arthritis Res Ther 2008; 10:R97. [PMID: 18718031 PMCID: PMC2575611 DOI: 10.1186/ar2484] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 07/28/2008] [Accepted: 08/22/2008] [Indexed: 12/23/2022] Open
Abstract
Introduction The tumour necrosis factor (TNF) family ligands BAFF (B-cell activating factor of TNF family) and APRIL (a proliferation-inducing ligand) are essential for B-cell survival and function. Elevated serum levels of BAFF and APRIL have been reported earlier in patients with systemic lupus erythematosus (SLE). Since autoantibody formation in the central nervous system (CNS) is a distinct feature of neuropsychiatric SLE (NPSLE), we have investigated whether NPSLE is associated with an enhanced intrathecal production of APRIL and BAFF. Methods Levels of BAFF and APRIL in cerebrospinal fluid (CSF) and serum from healthy controls, SLE patients without CNS involvement, and patients with NPSLE were determined by enzyme-linked immunosorbent assay. Interleukin-6 (IL-6) levels were determined by an IL-6-specific bioassay. Results SLE patients had levels of APRIL in CSF that were more than 20-fold higher and levels of BAFF in CSF that were more than 200-fold higher than those of healthy controls. Separate analyses of SLE patients with and without CNS involvement revealed that NPSLE patients had enhanced levels of APRIL in CSF. BAFF and APRIL were likely produced locally in the CNS as CSF and serum levels did not correlate. Moreover, CSF levels of APRIL correlated with BAFF but not with IL-6, suggesting that APRIL and BAFF in the CNS are regulated together but that they are produced independently of IL-6. Conclusion To our knowledge this is the first study to show elevated levels of BAFF and APRIL in CSF of SLE patients. APRIL was augmented in NPSLE patients compared with SLE patients without CNS involvement. APRIL and BAFF antagonists breeching the blood-brain barrier therefore could have beneficial effects on SLE patients, in particular patients with NPSLE.
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