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Zhang P, Feng Y, Xu T, Li Y, Xia J, Zhang H, Sun Z, Tian W, Zhang J. Brain white matter microstructural alterations in patients with systemic lupus erythematosus: an automated fiber quantification study. Brain Imaging Behav 2024:10.1007/s11682-024-00861-2. [PMID: 38332385 DOI: 10.1007/s11682-024-00861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
This study aimed to identify damaged segments of brain white matter fiber tracts in patients with systemic lupus erythematosus (SLE) using diffusion tensor imaging (DTI)-based automated fiber quantification (AFQ), and analyze their relationship with cognitive impairment. Clinical and imaging data for 39 female patients with SLE and for 44 female healthy controls (HCs) were collected. AFQ was used to track whole-brain white matter tracts in each participant, and each tract was segmented into 100 equally spaced nodes. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated at each node. Correlations were also explored between DTI metrics in the damaged segments of white matter fiber tracts and neuropsychological test scores of patients with SLE. Compared with HCs, SLE patients exhibited significantly lower FA values, and significantly higher MD, AD, RD values in many white matter tracts (all P < 0.05, false discovery rate-corrected). FA values in nodes 97-100 of the left inferior fronto-occipital fasciculus (IFOF) positively correlated with the mini-mental state examination score. AFQ enables precise and accurate identification of damage to white matter fiber tracts in brains of patients with SLE. FA values in the left IFOF correlate with cognitive impairment in SLE.
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Affiliation(s)
- Peng Zhang
- Graduate School of Dalian Medical University, Liaoning, 116044, China
- The First Affiliated Hospital of Baotou Medical College, Baotou, 014010, China
| | - Yanhong Feng
- Graduate School of Dalian Medical University, Liaoning, 116044, China
| | - Tianye Xu
- Graduate School of Dalian Medical University, Liaoning, 116044, China
| | - Yifan Li
- School of Medicine, Nantong University, Jiangsu, 226019, China
| | - Jianguo Xia
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China.
| | - Hongxia Zhang
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China.
| | - Zhongru Sun
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China
| | - Weizhong Tian
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China
| | - Ji Zhang
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China
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de Sousa DC, Sobreira EST, Feitosa WLQ, Aires TMPM, Araújo LPP, Silva ALC, Joventino CB, Silveira NMT, Chaves-Filho AJM, Macêdo DS, Braga-Neto P. Cognitive dysfunction in systemic lupus erythematosus is associated with disease activity and oxidative stress: a comparative study with rheumatoid arthritis for identifying biomarkers. BMC Neurosci 2023; 24:66. [PMID: 38093175 PMCID: PMC10717202 DOI: 10.1186/s12868-023-00839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The prevalence and pathophysiological mechanisms of cognitive deficits (CD) Systemic Lupus Erythematosus (SLE) and Rheumatoid arthritis (RA) are very heterogeneous and poorly understood. We characterized CD in patients with SLE compared with RA patients and healthy controls. We compared the neuropsychological profile of SLE and RA with patients' oxidative/inflammatory biomarkers for CD. METHODS We performed a cross-sectional study, including 50 SLE patients, 29 RA patients, and 32 healthy controls. SLEDAI and DAS28 assessed disease activity. SF-36 questionnaire and a battery of cognitive tests were applied to all participants. Blood samples were collected to determine IL-6, S100ß, myeloperoxidase (MPO), malondialdehyde and reduced glutathione (GSH) alterations. RESULTS In the SLE group, higher GSH was associated with the absence of CD (With CD = 69 ± 49, Without CD = 112 ± 81, p = 0.030), while higher IL-6 was associated with the presence of CD in the RA group (With CD = 603 ± 173, Without CD = 431 ± 162, p = 0.032). Regarding specific cognitive domains, in SLE higher MPO was associated with poor performance in reasoning and abstraction (p = 0.039), higher IL-6 was associated with poor performance in inhibitory control and attention (p = 0.031), and higher GSH was associated with better performance in memory(p = 0.021). Higher SLEDAI was associated with poor performance in semantic fluency(p = 0.031), inhibitory control, and attention in the SLE group(p = 0.037). In the RA group, higher DAS-28 was associated with poor performance in executive functions(p = 0.016) and phonemic fluency (p = 0.003). CONCLUSION SLE patients' disease activity, inflammatory state, and oxidative stress were associated with CD. In RA patients, CD was associated with disease activity and inflammatory state. These results encourage further studies with larger samples aiming to confirm oxidative stress parameters as biomarkers of CD in SLE patients.
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Affiliation(s)
| | - Emmanuelle Silva Tavares Sobreira
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Unichristus University Center, Fortaleza, Ceará, Brazil
| | | | | | | | | | - Caroline Brandão Joventino
- Medical School Graduate Program, Faculty of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | | | - Adriano José Maia Chaves-Filho
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Danielle Silveira Macêdo
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
- National Institute for Translational Medicine (INCT-TM, CNPq), Fortaleza, Ceará, Brazil
| | - Pedro Braga-Neto
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
- Center of Health Sciences, State University of Ceará (UECE), Fortaleza, Ceará, Brazil.
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Carlos AF, Graff-Radford J, Crum BA, Machulda MM, Pham NTT, Lowe VJ, Whitwell JL, Josephs KA. Antiphospholipid syndrome mimicking posterior cortical atrophy and the "railroad track" sign on brain fluorodeoxyglucose-positron emission tomography. J Neurol Sci 2023; 448:120615. [PMID: 36959061 PMCID: PMC10407999 DOI: 10.1016/j.jns.2023.120615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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Autoimmunity, COVID-19 Omicron Variant, and Olfactory Dysfunction: A Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13040641. [PMID: 36832129 PMCID: PMC9955947 DOI: 10.3390/diagnostics13040641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Smelling is a critical sense utilized daily. Consequently, smelling impairment or anosmia may lead to a reduction in life quality. Systemic diseases and particular autoimmune conditions can impair olfactory function; among others are Systemic Lupus Erythematosus, Sjögren Syndrome, and Rheumatoid Arthritis. Interactions between the olfactory process and the immune systems cause this phenomenon. Alongside autoimmune conditions, in the recent COVID-19 pandemic, anosmia was also described as a prevalent infection symptom. Nevertheless, the occurrence of anosmia is significantly less common in Omicron-infected patients. Several theories have been proposed to explain this phenomenon. One possibility is that the Omicron variant preferentially enters host cells via endocytosis, rather than plasma cell membrane fusion. This endosomal pathway is less dependent on the activation of Transmembrane serine protease 2 (TMPRSS2), expressed at the olfactory epithelium. As a result, the Omicron variant may have reduced efficiency in penetrating the olfactory epithelium, leading to a lower prevalence of anosmia. Furthermore, olfactory changes are known to be associated with inflammatory conditions. The Omicron variant elicits a less robust autoimmune and inflammatory response, believed to reduce the probability of anosmia. This review elaborates on the commonalities and differences in autoimmune and COVID-19 omicron-associated anosmia.
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Raghunath S, Glikmann-Johnston Y, Golder V, Kandane-Rathnayake R, Morand EF, Stout JC, Hoi A. Clinical associations of cognitive dysfunction in systemic lupus erythematosus. Lupus Sci Med 2023; 10:10/1/e000835. [PMID: 36854540 PMCID: PMC9980376 DOI: 10.1136/lupus-2022-000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Cognitive dysfunction in SLE is common, but clinical risk factors are poorly understood. This study aims to explore the associations of cognitive dysfunction in SLE with disease activity, organ damage, biomarkers and medications. METHODS We performed cross-sectional cognitive assessment using a conventional neuropsychological test battery, with normative values derived from demographically matched healthy subjects. Endpoints included two binary definitions of cognitive dysfunction and seven individual cognitive domain scores. Clinical parameters included disease activity (SLEDAI-2K) and organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). We performed regression analyses to determine associations between clinical parameters and cognitive endpoints. RESULTS 89 patients with SLE were studied, with median age of 45 and disease duration of 15 years. Organ damage was significantly associated with severe cognitive dysfunction (OR 1.49, CI 1.01-2.22) and worse cognitive test performance in three of the seven individual cognitive domains. In contrast, no significant associations were found between SLEDAI-2K at the time of cognitive assessment and any cognitive endpoints on multivariate analysis. Higher time-adjusted mean SLEDAI-2K was associated with better verbal memory scores but had no significant associations with other cognitive endpoints. The presence of anti-dsDNA antibodies and high IFN gene signature were negatively associated with severe cognitive dysfunction; there were no significant associations with the other autoantibodies studied or any medications. Substance use was significantly associated with lower psychomotor speed. Only 8% of patients who had cognitive dysfunction on testing had been recognised by clinicians on their SDI score. CONCLUSIONS In SLE, cognitive dysfunction was positively associated with organ damage, but not associated with disease activity, and serological activity and high IFN signature were negatively associated. Cognitive dysfunction was poorly captured by clinicians. These findings have implications for preventative strategies addressing cognitive dysfunction in SLE.
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Affiliation(s)
- Sudha Raghunath
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia .,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
| | - Yifat Glikmann-Johnston
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Vera Golder
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Rheumatology Department, Monash Health, Melbourne, Victoria, Australia
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Khan MI, Qureshi H, Akhtar S, Bae SJ, Hassan F. Prevalence of neuropsychiatric disorders in patients with systemic lupus erythematosus in Pakistan: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1098734. [PMID: 36816415 PMCID: PMC9931908 DOI: 10.3389/fpsyt.2023.1098734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION By conducting a systematic review and meta-analysis, we investigated the prevalence of neuropsychiatric (NP) symptoms among systemic lupus erythematosus (SLE) patients in Pakistan. METHODS In this review work, three electronic databases (Web of Science, MEDLINE, and Google Scholar) and local databases were screened for 20 years from 1 January 2002 to 30 September 2022, to identify the articles evaluating the prevalence of NP symptoms in SLE patients in Pakistan. We performed a random-effects meta-analysis to estimate the prevalence of NPSLE. Statistical heterogeneity was measured by the I2 index, and subgroup meta-analyses were used to access the statistical heterogeneity. Furthermore, meta-regression models were used to examine the associations between prevalence estimates and study characteristics of interest. Three independent authors reviewed existing studies, extracted data, and rated the qualities of selected studies. This review was registered on PROSPERO (Registration no. CRD42022361798). RESULTS Thirteen studies met the inclusion criteria out of the 322 studies with a total of 2,003 SLE patients for this systematic review and meta-analysis. The prevalence of NP disorders in SLE patients was estimated to be 30.42% (95% CI:18.26-44.11%), with cognitive dysfunction being the most common (31.51%; 95% CI:1.28-76.27%), followed by headache (10.22%; 95% CI: 0.00-33.43%), seizures (5.96%; 95% CI: 3.80-8.53%), psychosis (3.64%; 95% CI: 2.38-5.13%), and neuropathy is the least common (0.86%; 95% CI: 0.00-2.74%). The heterogeneity between studies was significant (p < 0.01). The pooled prevalence of NP disorders among SLE patients was found highest in Punjab (41.21%) and lowest in Sindh (17.60%). CONCLUSION Findings from this study revealed that SLE patients have a high prevalence of NP disorders. The most common symptoms were cognitive dysfunctions, headaches, seizures, psychosis, and neuropathy. Clinicians can manage these potentially deadly and disabling diseases more effectively if they understand the incidence of each NP symptom in SLE patients. NP symptoms among SLE patients are at their peak in Pakistan; policymakers should devise preventive strategies to curb the disease. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record. php?RecordID=361798, identifier CRD42022361798.
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Affiliation(s)
- Muhammad Imran Khan
- Department of Industrial Engineering, Hanyang University, Seoul, Republic of Korea
| | - Humera Qureshi
- Department of Industrial Engineering, Hanyang University, Seoul, Republic of Korea
| | - Sohail Akhtar
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan
| | - Suk Joo Bae
- Department of Industrial Engineering, Hanyang University, Seoul, Republic of Korea
| | - Fazal Hassan
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan
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Fan KQ, Huang T, Yu JS, Li YY, Jin J. The clinical features and potential mechanisms of cognitive disorders in peripheral autoimmune and inflammatory diseases. FUNDAMENTAL RESEARCH 2022. [DOI: 10.1016/j.fmre.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Ferrara V, Perrone ME, Mina C, Ceccarelli F, Olivieri G, Fattapposta F, Conti F. Science and visual Arts: Binomial or Dichotomy? A Pilot study in Systemic Lupus Erythematosus patients. Lupus 2022; 31:1744-1749. [PMID: 36189670 DOI: 10.1177/09612033221131179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
Abstract
Scientific literature demonstrated the impairment in cognitive/executive functions and pragmatic language in SLE patients, potentially involving also asymptomatic subjects. The present study focuses on the assessment in an SLE cohort of emotional intelligence, which is an ability regulated by the network of the executive functions, cognitive abilities involved in the initiation, planning, organization, and regulation of achievement-oriented behaviors: with emotional. Thus, emotional intelligence, defined as the ability to reason with emotions, was evaluated in a SLE cohort diagnosed according to the 1997 American College of Rheumatology criteria. As control healthy subjects were enrolled. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), a skill-scale that measures the ability to perform tasks and solve emotional problems, was administered to patients and controls. Second, a group of SLE patients underwent the Visual Thinking Strategies (VTS) method in order to assess the potential impact of art in cognitive skills like critical thinking, problem solving, and emotional intelligence quotient. The protocol also included the evaluation of the improvement of some skills using a validated VTS skill grid. Self-reported scales for anxiety and depression were performed to rule out the influence of mood disorders on emotional intelligence. The present study demonstrated similar quotient scores of emotional intelligence in SLE patients and healthy controls. Furthermore, VTS method could help in improving this cognitive ability in patients, by implementing critical thinking and problem solving, promoting empathy, and improving tolerance to ambiguity and relational capacity.
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Affiliation(s)
- Vincenza Ferrara
- Art and Medical Humanities Lab - Pharmacy and Medicine Faculty, Sapienza University of Rome, Roma, Italy
| | | | - Concetta Mina
- Human Neurosciences Department Sapienza, University of Rome, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Giulio Olivieri
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | | | - Fabrizio Conti
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
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Al-Mughales JA. Anti-Nuclear Antibodies Patterns in Patients With Systemic Lupus Erythematosus and Their Correlation With Other Diagnostic Immunological Parameters. Front Immunol 2022; 13:850759. [PMID: 35359932 PMCID: PMC8964090 DOI: 10.3389/fimmu.2022.850759] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Antinuclear antibodies (ANA) are major immunodiagnostic tools in systemic lupus erythematosus (SLE); however, their clinical and pathogenic roles are not yet elucidated and are a subject of controversy. Objectives The aim of the study is to explore the pathogenic significance of ANA patterns among SLE patients, by analyzing their association with ANA titers, complement levels and other pathogenic immune markers, namely, anti-double-stranded DNA (anti-dsDNA), complements C3 and C4, rheumatoid factor (RF), anticardiolipin antibodies IgG (ACL IgG) and IgM (ACL IgM), Beta-2 Glycoprotein 1 Antibodies (β2-GP) IgG (β2-IgM) and IgM (β2-IgM), and lupus anticoagulant (LA). Method A comparative cross-sectional study was conducted among 495 SLE patients, who were diagnosed and classified by consultant rheumatologists according to the new European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 criteria. SLE immunodiagnostic profiles were analyzed including the following parameters: ANA antibody titers and staining patterns, anti-dsDNA, C3 and C4 levels, aCL, and anti-β2-GP and LA. Result The most frequently observed ANA patterns were the speckled (52.1%) and homogeneous (35.2%) patterns, while other patterns were rare representing less than 7% of the patients each. ANA titers were highest in patients with mixed pattern followed by the speckled pattern. Of all the investigated patterns, the peripheral pattern showed the most pathogenic immune profile, namely, highest levels of anti-dsDNA, lowest levels of C4, and highest levels of aCL and β2-GP IgG and IgM. Conclusion This retrospective study showed that speckled followed by homogeneous ANA patterns were predominant accounting for 52.1 and 35.2% of the patients. The ANA pattern showed several associations with other immune markers that are documented to have significant clinical implications in SLE. Peripheral, mixed, and speckled patterns were associated with higher profiles of immune markers indicative of a potential prognostic value of these patterns in SLE.
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Affiliation(s)
- Jamil A. Al-Mughales
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Clinical Laboratory Medicine, Diagnostic Immunology Division, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Cognitive Impairment in Anti-Phospholipid Syndrome and Anti-Phospholipid Antibody Carriers. Brain Sci 2022; 12:brainsci12020222. [PMID: 35203985 PMCID: PMC8870021 DOI: 10.3390/brainsci12020222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 12/29/2022] Open
Abstract
Cognitive impairment is frequently reported among anti-phospholipid syndrome (APS) patients as well as anti-phospholipid antibody (aPL) carriers, but it is less studied than other manifestations of this condition. Moreover, the exact prevalence of cognitive impairment in these patients has not been accurately determined, mainly due to inconsistency in the tools used to identify impairment, small sample sizes, and variability in the anti-phospholipid antibodies measured and positivity cutoffs. The notion of a direct pathogenic effect is supported by the observation that the higher the number of aPLs present and the higher the load of the specific antibody, the greater the risk of cognitive impairment. There is some evidence to suggest that besides the thrombotic process, inflammation-related pathways play a role in the pathogenesis of cognitive impairment in APS. The cornerstone treatments of APS are anti-coagulant and anti-thrombotic medications. These treatments have shown some favorable effects in reversing cognitive impairment, but solid evidence for the efficacy and safety of these treatments in the context of cognitive impairment is still lacking. In this article, we review the current knowledge regarding the epidemiology, pathophysiology, clinical associations, and treatment of cognitive impairment associated with APS and aPL positivity.
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Barraclough M, McKie S, Parker B, Elliott R, Bruce IN. The effects of disease activity, inflammation, depression and cognitive fatigue on resting state fMRI in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 61:SI39-SI47. [PMID: 34747435 DOI: 10.1093/rheumatology/keab734] [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: 06/29/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cognitive dysfunction (CD) and depression are interlinked comorbidities of SLE. They may be the result of altered brain mechanisms. This study aimed to examine SLE effects on functional connectivity (FC) within the default mode network (DMN) using resting state fMRI-and how depression may impact this. METHODS Demographic, clinical and psychiatric data were collected from 19 SLE-active, 23 SLE-stable and 30 healthy controls (HC) participants. A T2*-weighted rsfMR scan was acquired and analysed using independent component analysis (ICA). Group z-scores for nodes associated with the DMN were tested. Significant nodes were entered into a factor analysis. The combined factor was used in correlations with factors of interest. Significant variables were used in a mediation analysis. RESULTS 14 DMN nodes were defined using ICA. In five nodes, the SLE groups had significantly reduced FC compared with the HC group (p < 0.01). Factor analysis generated one factor that only depression score correlated with for both the HC group (rs=-0.510) and SLE groups combined (rs=-0.390). Mediation analysis revealed depression score accounted for 22% of the altered FC in the DMN. Disease state accounted for the remaining 78%. CONCLUSIONS Altered FC was evident in DMN nodes for SLE groups irrespective of disease activity. Depression accounts for some of this effect but SLE directly accounted for more. Further studies are needed to assess if these changes may be a precursor to CD in SLE. If so, rs-fMRI could be an early marker for CD in SLE and help in future CD in SLE treatment trials.
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Affiliation(s)
- Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Shane McKie
- FBMH Platform Sciences, Enabling Technologies & Infrastructure, FBMH Research & Innovation, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
| | - Ben Parker
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Seet D, Allameen NA, Tay SH, Cho J, Mak A. Cognitive Dysfunction in Systemic Lupus Erythematosus: Immunopathology, Clinical Manifestations, Neuroimaging and Management. Rheumatol Ther 2021; 8:651-679. [PMID: 33993432 PMCID: PMC8217391 DOI: 10.1007/s40744-021-00312-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022] Open
Abstract
Cognitive dysfunction (CD) is a common yet often clinically subtle manifestation that considerably impacts the health-related quality of life in patients with systemic lupus erythaematosus (SLE). Given the inconsistencies in CD assessment and challenges in its attribution to SLE, the reported prevalence of CD differs widely, ranging from 3 to 88%. The clinical presentation of CD in SLE is non-specific and may manifest concurrently with overt neuropsychiatric illness such as psychosis or mood disorders or as isolated impairment of attention, working memory, executive dysfunction or processing speed. Despite the lack of standardized and sensitive neuropsychological tests and validated diagnostic biomarkers of CD in SLE, significant progress has been made in identifying pathogenic neural pathways and neuroimaging. Furthermore, several autoantibodies, cytokines, pro-inflammatory mediators and metabolic factors have been implicated in the pathogenesis of CD in SLE. Abrogation of the integrity of the blood-brain barrier (BBB) and ensuing autoantibody-mediated neurotoxicity, complement and microglial activation remains the widely accepted mechanism of SLE-related CD. Although several functional neuroimaging modalities have consistently demonstrated abnormalities that correlate with CD in SLE patients, a consensus remains to be reached as to their clinical utility in diagnosing CD. Given the multifactorial aetiology of CD, a multi-domain interventional approach that addresses the risk factors and disease mechanisms of CD in a concurrent fashion is the favourable therapeutic direction. While cognitive rehabilitation and exercise training remain important, specific pharmacological agents that target microglial activation and maintain the BBB integrity are potential candidates for the treatment of SLE-related CD.
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Affiliation(s)
- Dominic Seet
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Nur Azizah Allameen
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiacai Cho
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Rosa RF, Ugolini-Lopes MR, Gandara APR, Vendramini MBG, Campanholo KR, Dutra L, de Andrade DCO. Cognitive dysfunction and serum levels of brain-derived neurotrophic factor (BDNF) in primary anti-phospholipid syndrome (PAPS). Rheumatology (Oxford) 2021; 60:179-187. [PMID: 32613245 DOI: 10.1093/rheumatology/keaa252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/14/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Cognitive dysfunction (CD) is a poorly understood non-stroke central neurological manifestation in anti-phospholipid syndrome (APS). Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in neural plasticity and could potentially be a biomarker of CD in primary APS (PAPS). The aim of the study is to assess CD in PAPS patients and to evaluate its association with clinical data, anti-phospholipid antibodies and serum BDNF levels. METHODS This cross-sectional study compared 44 PAPS patients and 20 healthy controls matched for age, gender and education. PAPS patients and controls underwent a standardized cognitive examination. The demographic, clinical and laboratory characteristics of patients were recorded. Serum BDNF was measured by Enzyme Linked Immunosorbent. RESULTS Fourteen (31.8%) of the 44 patients with PAPS had CD compared with only one (5%) healthy control (P =0.019). PAPS patients presented lower serum BDNF levels when compared with controls (P =0.007). Lower levels of BDNF were associated with CD in PAPS patients (P =0.032). In the univariate analysis, a positive association was found between CD and livedo reticularis, deep vein thrombosis, stroke, seizure, smoking as well as a negative association with Mini Mental State Examination and serum BDNF. According to multivariate analysis, the only independent predictor of CD in PAPS was stroke (OR 137.06; 95% CI: 4.73, 3974.32; P =0.004). CONCLUSIONS CD is commonly reported in PAPS patients; however, its assessment lacks in standards and objective screening tests. The association between CD and low serum BDNF suggests that this neurotrophin can be a promising biomarker for PAPS cognitive impairment.
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Affiliation(s)
| | | | | | | | | | - Livia Dutra
- Neurology Division, Escola Paulista de Medicina (EPM), São Paulo, Brazil
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14
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Cognitive impairment in elderly patients with rheumatic disease and the effect of disease-modifying anti-rheumatic drugs. Clin Rheumatol 2020; 40:1221-1231. [PMID: 32862311 DOI: 10.1007/s10067-020-05372-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Recent development of biologic disease-modifying anti-rheumatic drugs (DMARDs) has led to better control of disease activity among patients with chronic rheumatological diseases. Many patients with rheumatic disease are living longer, adding to the growing elderly population. Rheumatic diseases, most notably rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), are known to increase the risk of cognitive impairment. Systemic inflammation associated with chronic rheumatological diseases has been postulated to be key driver of cognitive decline. Recent development of classic and biologic DMARDs have led to better control of disease activity among patients with rheumatic conditions. It is proposed that strict control of systemic inflammation will significantly lower the risk of cognitive impairment among patients with rheumatic disease. The impact of classic DMARDs on cognitive function appears to be variable. On the other hand, biologic DMARDs, specifically antitumor necrosis factor (TNF) drugs (i.e., etanercept), have been shown to significantly lower the risk of dementia. Experimental studies on IL-1, IL-6, and B and T cell blockade are promising. However, clinical data is limited. Preclinical studies on targeted therapies, specifically JAK/STAT inhibitors, also show promising results. Additional studies are necessary to better understand the impact of these newer biologic agents on cognitive function in elderly patients with rheumatic disease. Key points • Patients with chronic rheumatic conditions are beginning to live longer, adding to the elderly population. • Patients with chronic rheumatologic disease are at increased risk of cognitive impairment compared to the general population. • Recent development of biologic (i.e., TNF, IL-1, IL-6) and targeted drugs (i.e., Janus kinase inhibitors) have led to better control of disease activity. • Current evidence suggests that TNF inhibitors may have beneficial effects on cognitive function. However, evidence on newer biologic and targeted therapies is limited.
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15
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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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16
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Ceccarelli F, Pirone C, Mina C, Mascolo A, Perricone C, Massaro L, Spinelli FR, Alessandri C, Valesini G, Conti F. Pragmatic language dysfunction in systemic lupus erythematosus patients: Results from a single center Italian study. PLoS One 2019; 14:e0224437. [PMID: 31682630 PMCID: PMC6827908 DOI: 10.1371/journal.pone.0224437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/14/2019] [Indexed: 01/07/2023] Open
Abstract
Background Cognitive impairment (CI) in systemic lupus erythematosus (SLE) is a frequent neuropsychiatric manifestation affecting several domains, even in apparently asymptomatic patients. Current research revealed that the typical CI pattern affects frontal-subcortical circuit and thus executive functions. The impairment of non-literal language or pragmatic language (PL), including metaphors, idioms, inferences or irony has been well described in several conditions such as autism disorders, Parkinson’s disease, brain injury and even in earlier phases of neurodegenerative processes. Even if PL neuro-anatomy remains controversial, correlation between executive dysfunctions and non-literal language involvement has been reported both in traumatic injury and mild cognitive impairment patients. Nonetheless, no specific study has been performed to evaluate PL impairment in SLE patients so far. Objectives We aimed at assessing the PL domain in a Italian monocentric SLE cohort in comparison to healthy controls, matched to age and education, through a specific battery, the batteria sul linguaggio dell'emisfero destro (BLED). Secondly, we focused attention on possible correlations between CI and clinical and laboratory SLE-related features. Methods Forty adult patients affected by SLE, according to the American College of Rheumatology (ACR) criteria, and thirty healthy subjects were enrolled consecutively in this cross-sectional study. The protocol included complete physical examination, extensive clinical and laboratory data collection (comprehensive of demographics, past medical history, co-morbidities, disease activity, chronic damage evaluation, previous and concomitant treatments) and cognitive assessment for five different domains: memory, attention, pragmatic language, executive and visuospatial functions. Self-reported scale for anxiety and depression were performed to exclude the influence of mood disorders on cognitive dysfunction. Results We studied 40 Caucasian SLE patients [male (M)/ female (F) 3/37; mean±standard deviation (SD) age 45.9±10.1 years, mean±SD disease duration 120.8±81.2 months] and 30 healthy subjects (M/F 9/21; mean±SD age 41.3±13 years). According to the low level of disease activity and damage (mean±SD Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) of 1.3±2.3, mean±SD Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) of 0.2±0.5), only 30% of patients was on glucocorticoid treatment at the study entry. PL was the most compromised domain in terms of Mean Domain Z scores. As for the Domain Cognitive Dysfunction score, a deficit of PL was observed in 45% of patients and was significantly more prevalent than memory, executive and visuospatial functions impairment (P = 0.0002, P = 0.0002 and P<0.000001, respectively). According to Global Cognitive Dysfunction score, 25% of patients experienced a mild impairment and 7.5% a moderate one. Anti-phospholipid antibodies positivity was significantly associated with memory impairment (P<0.0005), whereas the presence of other neuropsychiatric events was associated with executive dysfunctions (P<0.05); no further significant association nor correlation were identified. Conclusion In this study we evaluated for the first time PL in SLE patients finding a dysfunction in almost half of patients. The dysfunction of PL was significantly more frequent than the other domains assessed.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Carmelo Pirone
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Concetta Mina
- Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma, Rome, Italy
| | - Alfredo Mascolo
- Clinica Neurologica, Dipartimento di Neuroscienze, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Carlo Perricone
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Laura Massaro
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Guido Valesini
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
- * E-mail:
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17
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Predictors of damage accrual in systemic lupus erythematosus: a longitudinal observational study with focus on neuropsychological factors and anti-neuronal antibodies. Clin Rheumatol 2019; 38:3129-3137. [PMID: 31367942 DOI: 10.1007/s10067-019-04707-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/27/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Central nervous system disease occurs in over 20% of patients with systemic lupus erythematosus (SLE) resulting in major morbidity and damage. Cognitive dysfunction is common in SLE, but the cause remains uncertain and treatment options are limited. This study explores the influence of clinical, neuropsychological factors and anti-neuronal antibodies on lupus damage accrual. METHOD A prospective cohort with 99 SLE patients recruited between 2008 and 2013 and followed up in 2016 was established. Baseline evaluations were depression (MINI-Plus), cognitive function evaluating attention, visuospatial memory and executive functions, and anti-neuronal antibodies. Activity index (SLEDAI-2K) and SLICC/ACR Damage Index (SDI) were assessed at baseline and last follow-up. RESULTS At baseline, median (interquartile range) age was 36.0 years (27.0-45.0), disease duration 3.7 years (0.4-12.4), SLEDAI-2K 6.0 (3.0-12.0), and SDI score 1.0 (0-1.0). Major depression was present in 23%, cognitive deficit in 18%, and received immunomodulators in 36%. Anti-dsDNA/N-methyl-D-aspartate receptor antibodies were present in 19%, anti-ribosomal P in 12%, and anti-neuronal surface P antigen (NSPA) in 5%. After a median follow-up of 55 months (interquartile range 39-78), 11% had damage accrual. In a multivariate analysis, baseline SDI, SLEDAI-2K, and immunomodulators use were associated with final damage, whereas SLEDAI-2K and immunomodulator use were also associated with accrual damage. Models including anti-NSPA showed impact on final and accrual damage. Cognitive deficit, depression, and other autoantibodies were not predictors. CONCLUSIONS Disease activity and immunomodulator use associate with lupus damage. Of the anti-neuronal antibodies examined, anti-NSPA emerged as a potential poor prognostic factor, probably related to severe SLE onset requiring elevated corticosteroid doses. Key Points • Anti-NSPA may be a worse prognostic factor in SLE. • Other neuropsychological factors do not influence damage.
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18
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Kanapathy A, Nik Jaafar NR, Shaharir SS, Chan LF, Rozita M, Ch’ng SS. Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia. Lupus 2019; 28:854-861. [DOI: 10.1177/0961203319852153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden. Aims This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia. Methods A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong–Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI). Results The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender ( p = 0.04), educational level ( p = 0.00), WBFPS score ( p = 0.035) and anticardiolipin IgM ( p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06–52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47–13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45–32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment. Conclusion Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.
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Affiliation(s)
- A Kanapathy
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - N R Nik Jaafar
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - S S Shaharir
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - L F Chan
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - M Rozita
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - S S Ch’ng
- Department of Medicine, Selayang Hospital, Selangor, Malaysia
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19
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Bucci T, Menichelli D, Pignatelli P, Triggiani M, Violi F, Pastori D. Relationship of Antiphospholipid Antibodies to Risk of Dementia: A Systematic Review. J Alzheimers Dis 2019; 69:561-576. [DOI: 10.3233/jad-181294] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Tommaso Bucci
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Danilo Menichelli
- I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Massimo Triggiani
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Francesco Violi
- I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
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20
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Arvanitakis Z, Capuano AW, Brey R, Fleischman DA, Arfanakis K, Buchman AS, Schneider JA, Levine SR, Bennett DA. Antiphospholipid Antibodies: Cognitive and Motor Decline, Neuroimaging and Neuropathology. Neuroepidemiology 2019; 53:100-107. [PMID: 31067547 DOI: 10.1159/000500157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/03/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Few data are available on associations of antiphospholipid (aPL) antibodies with cognitive and motor decline in aging, and cerebrovascular disease on in vivo neuroimaging and postmortem neuropathology. METHODS This longitudinal, clinical-pathologic study (aPL antibodies, brain infarcts, and cognitive and motor decline in aging), was derived from 2 ongoing community-based cohort studies. A panel of 3 aPL antibodies was assayed in serum from 956 older individuals (mean age = 81.1 years; 72% women). Serum was also tested in a subset for markers of inflammation (C-reactive protein [CRP]) and blood-brain barrier breakdown (matrix metalloproteinases, MMPs). Annual clinical evaluations documented cognitive (17 neuropsychological tests) and motor function including parkinsonism. Cerebrovascular disease data were derived from in vivo neuroimaging and postmortem neuropathologic evaluations (699 individuals). We examined associations of aPL with cognitive and motor decline, other serum markers, neuroimaging, and neuropathology. RESULTS Of 956 individuals, 197 (20.6%) had aPL positivity, defined as positivity on any of the assays, at the time of first measurement. During a mean follow-up of 6.6 years (SD 4), overall aPL positivity was not associated with change in global cognition (estimate = -0.005, SE 0.011; p = 0.622) or parkinsonian signs (estimate = -0.003, SE 0.017; p = 0.860). aPL were not associated with serum CRP or MMPs (both p > 0.268). aPL were not associated with in vivo brain magnetic resonance imaging white matter hyperintensities or infarcts (both p > 0.376). Among those autopsied, aPL were not associated with pathologically confirmed brain infarcts, or cerebral atherosclerosis or arteriolosclerosis (all p≥ 0.447). CONCLUSIONS In older individuals followed longitudinally, aPL do not relate to cognitive or motor decline, inflammation, or cerebrovascular disease on in vivo neuroimaging or postmortem neuropathology.
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Affiliation(s)
- Zoe Arvanitakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA, .,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA,
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Robin Brey
- Department of Neurology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.,Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven R Levine
- Department of Neurology, State University of New York College of Medicine, Downstate Medical Center, and Kings County Hospital Center, Brooklyn, New York, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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21
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Functional connectivity changes in core resting state networks are associated with cognitive performance in systemic lupus erythematosus. J Comp Neurol 2019; 527:1837-1856. [DOI: 10.1002/cne.24656] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/29/2018] [Accepted: 01/17/2019] [Indexed: 12/23/2022]
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22
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Gris JC, Cyprien F, Bouvier S, Cochery-Nouvellon E, Lavigne-Lissalde G, Mercier E, Balducchi JP. Antiphospholipid antibodies are associated with positive screening for common mental disorders in women with previous pregnancy loss. The NOHA-PSY observational study. World J Biol Psychiatry 2019; 20:51-63. [PMID: 28532221 DOI: 10.1080/15622975.2017.1333146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Case reports describe neuropsychiatric manifestations associated with antiphospholipid antibodies (aPlAbs). In patients sharing the same symptoms fulfilling the antiphospholipid syndrome (APS) clinical criteria, the prevalence of common mental disorders has, however, never been studied. METHODS We observed women with three consecutive abortions before the 10th week of gestation or one foetal loss at or beyond the 10th week. We compared the prevalence of common psychiatric disorders detected through screening using the Mini International Neuropsychiatric Interview, 10 years after inclusion, in women with APS (n = 506), women negative for aPlAbs but carrying the F5rs6025 or F2rs1799963 thrombogenic polymorphism (n = 269), and women with negative thrombophilia screening results as controls (n = 764). RESULTS Similar prevalence values were obtained for controls and women bearing one of the two thrombogenic polymorphisms. Women with APS more frequently had mood disorders (relative risk (RR) 1.57 (1.262-1.953), P = .0001) and anxiety (RR 1.645 (1.366-1.979), P < .0001). Within the APS group, lupus anticoagulant (LA) and anti-β2GP1 IgG, or triple positivity, were strong risk factors for mood disorders. CONCLUSIONS Women with obstetric APS have a higher risk of positive screening for common mental disorders than women without APS.
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Affiliation(s)
- Jean-Christophe Gris
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France.,c Laboratory of Hematology, Faculty of Pharmacy and Biological Sciences , University of Montpellier , Montpellier , France
| | - Fabienne Cyprien
- d Department of Neurosurgery , University Hospital , Montpellier , France.,e Inserm U1061 , "Neuropsychiatrie: recherche épidémiologique et clinique" , Montpellier , France
| | - Sylvie Bouvier
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France.,c Laboratory of Hematology, Faculty of Pharmacy and Biological Sciences , University of Montpellier , Montpellier , France
| | - Eva Cochery-Nouvellon
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France
| | - Géraldine Lavigne-Lissalde
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France
| | - Erick Mercier
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France.,c Laboratory of Hematology, Faculty of Pharmacy and Biological Sciences , University of Montpellier , Montpellier , France
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Nalakonda G, Islam M, Chukwu VE, Soliman A, Munim R, Abukraa I. Psycho-rheumatic Integration in Systemic Lupus Erythematosus: An Insight into Antibodies Causing Neuropsychiatric Changes. Cureus 2018; 10:e3091. [PMID: 30324045 PMCID: PMC6171782 DOI: 10.7759/cureus.3091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The main purpose of this paper is to bring together all the antibodies and markers related to neurological and psychiatric manifestations in systemic lupus erythematosus and also the pharmacology that could help treat these symptoms. Existing research data regarding specific antibodies involved in the disease process and drugs that were being studied was collected and analyzed. After reviewing the studies published by various authors, symptoms were shown to be mainly caused by antibodies against N-methyl-D-aspartate receptor (NMDAR) antibodies, anti-endothelial, anti-ribosomal P, antiphospholipid antibodies, cytokines like interferons and chemokines. The monoclonal antibody rituximab has shown to be beneficial in some of the cases. Based on all the articles reviewed, the antibodies and cytokines showed the most effective evidence in causing the different manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE), but studies regarding the drugs being effective against all the symptoms are inconclusive as there are very few studies. Further research to support the drug’s effectiveness in managing the symptoms is needed. More studies are needed regarding early diagnosis of NPSLE using the antibodies as biomarkers as it could help in preventing these manifestations.
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Affiliation(s)
- Gouthami Nalakonda
- Medical Student, Chalmeda Anandrao Institute of Medical Sciences, Karimnagar, IND
| | - Mimsa Islam
- Internal Medicine, Sir Salimullah Medical College, Dhaka, USA
| | | | | | - Rujina Munim
- Miscellaneous, Sylhet Mag Osmani Medical College and Hospital, Sylhet, BGD
| | - Inas Abukraa
- Faculty of Medicine, Tripoli University, Tripoli, LBY
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Frauenknecht K, Leukel P, Weiss R, von Pein HD, Katzav A, Chapman J, Sommer CJ. Decreased hippocampal cell proliferation in mice with experimental antiphospholipid syndrome. Brain Struct Funct 2018; 223:3463-3471. [PMID: 29936552 DOI: 10.1007/s00429-018-1699-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
Abstract
The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies, which may trigger vascular thrombosis with consecutive infarcts. However, cognitive dysfunctions representing one of the most commonest neuropsychiatric symptoms are frequently present despite the absence of any ischemic brain lesions. Data on the structural and functional basis of the neuropsychiatric symptoms are sparse. To examine the effect of APS on hippocampal neurogenesis and on white matter, we induced experimental APS (eAPS) in adult female Balb/C mice by immunization with β2-glycoprotein 1. To investigate cell proliferation in the dentate gyrus granular cell layer (DG GCL), eAPS and control mice (n = 5, each) were injected with 5-bromo-2'-deoxyuridine (BrdU) once a day for 10 subsequent days. Sixteen weeks after immunization, eAPS resulted in a significant reduction of BrdU-positive cells in the DG GCL compared to control animals. However, double staining with doublecortin and NeuN revealed a largely preserved neurogenesis. Ultrastructural analysis of corpus callosum (CC) axons in eAPS (n = 6) and control mice (n = 7) revealed no significant changes in CC axon diameter or g-ratio. In conclusion, decreased cellular proliferation in the hippocampus of eAPS mice indicates a limited regenerative potential and may represent one neuropathological substrate of cognitive changes in APS while evidence for alterations of white matter integrity is lacking.
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Affiliation(s)
- Katrin Frauenknecht
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. .,Institute of Neuropathology, University Hospital of Zurich, University of Zurich, Schmelzbergstr. 12, 8091, Zurich, Switzerland.
| | - Petra Leukel
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Ronen Weiss
- Department of Neurology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Harald D von Pein
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Aviva Katzav
- Department of Neurology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Joab Chapman
- Department of Neurology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Clemens J Sommer
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Focus Program Translational Neurosciences (FTN), Rhine Main Neuroscience Network (rmn2), Mainz, Germany
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Ceccarelli F, Perricone C, Pirone C, Massaro L, Alessandri C, Mina C, Marianetti M, Spinelli FR, Valesini G, Conti F. Cognitive dysfunction improves in systemic lupus erythematosus: Results of a 10 years prospective study. PLoS One 2018; 13:e0196103. [PMID: 29723209 PMCID: PMC5933733 DOI: 10.1371/journal.pone.0196103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/08/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Cognitive impairment (CI) has been described in 3-80% of Systemic lupus erythematosus (SLE) patients but only short-term studies evaluated its over-time changes, suggesting that CI is usually a stable finding. We aimed at evaluating the changes of SLE-related CI in a 10-years prospective single center cohort study. METHODS We evaluated 43 patients (M/F 5/38; mean age = 45.7±10.1 years; mean disease duration = 230.8±74.3 months) at baseline (T0) and after 10 years (T1). A test battery designed to detect fronto-subcortical dysfunction across five domains (memory, attention, abstract reasoning, executive and visuospatial function) was administered. A global cognitive dysfunction score (GCD) was obtained and associated with clinical and laboratory features. RESULTS Prevalence of CI was 20.9% at T0 and 13.9% at T1 (P = NS). This impairment was prevalently mild at T0 (55.5%) and mild or moderate at T1 (36.3% for both degrees). After 10 years, CI improved in 50% of patients, while 10% worsened. Impaired memory (P = 0.02), executive functions (P = 0.02) and abstract reasoning (P = 0.03) were associated with dyslipidemia at T0. Worsening of visuospatial functions was significantly associated with dyslipidemia and Lupus Anticoagulant (P = 0.04 for both parameters). Finally, GCD significantly correlated with chronic damage measured by SLICC/damage index at T0 (r = 0.3; P = 0.04) and T1 (r = 0.3; P = 0.03). CONCLUSIONS For the first time, we assessed CI changes over 10-years in SLE. CI improved in the majority of the patients. Furthermore, we observed an improvement of the overall cognitive functions. These results could suggest that an appropriate management of the disease during the follow-up could be able to control SLE-related CI.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Carlo Perricone
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Carmelo Pirone
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Laura Massaro
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Concetta Mina
- Dipartimento di Neurologia e ORL, Sapienza Università di Roma, Rome, Italy
| | - Massimo Marianetti
- Dipartimento di Neurologia e ORL, Sapienza Università di Roma, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Guido Valesini
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Fabrizio Conti
- Lupus Clinic, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
- * E-mail:
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Meara A, Davidson N, Steigelman H, Zhao S, Brock G, Jarjour WN, Rovin BH, Madhoun H, Parikh S, Hebert L, Ayoub I, Ardoin SP. Screening for cognitive impairment in SLE using the Self-Administered Gerocognitive Exam. Lupus 2018; 27:1363-1367. [PMID: 29466913 DOI: 10.1177/0961203318759429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can affect the central nervous system in multiple ways, including causing cognitive dysfunction. Cognitive dysfunction is a common complaint of SLE patients yet diagnosis is challenging, time consuming, and costly. This study evaluated the Self-Administered Gerocognitive Exam (SAGE) as a screening test for cognitive impairment in a cohort of SLE patients. Methods A total of 118 SLE patients completed the SAGE. Providers completed the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborative Clinics Damage Index (SLICC-DI). SAGE scores were grouped into normal (>16) and abnormal (≤16) categories. Univariate and multivariate analyses were performed. Results Of the 118 participants, 21(18%) scored ≤16 on the SAGE instrument. In univariate analysis, race, ethnicity, household income, and SLICC-DI scores were associated with the SAGE ( p < 0.05). In multivariable analysis, abnormal SAGE score was independently associated with higher SLICC-DI score (odds ratio (OR) = 1.44, 95% confidence intervals 1.04-1.99, p = 0.03)), Hispanic ethnicity (OR = 43.4, 95% CI 3.1-601, p = 0.005), and lower household income (OR = 11.9 for ≤$15,000 vs >$50,000, 95% CI 2.45-57, p = 0.002). Conclusions In SLE patients, this study demonstrates an independent relationship between neurocognitive impairment (as measured by the SAGE) and higher lupus-related damage, as measured by the SLICC-DI, and lower household income. Abnormal SAGE scores were also associated with Hispanic ethnicity. A language barrier could explain this because the SAGE instrument was conducted in English only. The SAGE was feasible to measure in the clinic setting.
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Affiliation(s)
- A Meara
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - N Davidson
- 1 The Ohio State University College of Medicine, Columbus, OH, USA
| | - H Steigelman
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - S Zhao
- 3 The Ohio State University Center for Biostatistics, Columbus, OH, USA
| | - G Brock
- 3 The Ohio State University Center for Biostatistics, Columbus, OH, USA
| | - W N Jarjour
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - B H Rovin
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - H Madhoun
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - S Parikh
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - L Hebert
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - I Ayoub
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - S P Ardoin
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
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Altered white matter microstructure in lupus patients: a diffusion tensor imaging study. Arthritis Res Ther 2018; 20:21. [PMID: 29415762 PMCID: PMC5803933 DOI: 10.1186/s13075-018-1516-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether white matter microstructure is altered in patients suffering from systemic lupus erythematosus (SLE), and if so, whether such alterations differed between patients with and without neuropsychiatric symptoms. METHODS Structural MRI and diffusion tensor imaging (DTI) were performed in 64 female SLE patients (mean age 36.9 years, range 18.2-52.2 years) and 21 healthy controls (mean age 36.7 years, range 23.3-51.2 years) in conjunction with clinical examination, laboratory tests, cognitive evaluation, and self-assessment questionnaires. The patients were subgrouped according to the American College of Rheumatology Neuropsychiatric Systemic Lupus Erythematosus case definitions into non-neuropsychiatric SLE (nonNPSLE) and neuropsychiatric SLE (NPSLE). RESULTS Comparisons between the SLE group and healthy controls showed that the mean fractional anisotropy (FA) was significantly reduced in the right rostral cingulum (p = 0.038), the mid-sagittal corpus callosum (CC) (p = 0.050), and the forceps minor of the CC (p = 0.015). The mean diffusivity (MD) was significantly increased in the left hippocampal cingulum (p = 0.017). No significant differences in MD or FA values were identified between NPSLE and nonNPSLE patients. Disease duration among all SLE patients correlated significantly with reduced FA in the CC (p < 0.05). No correlations were found between DTI parameters and white matter hyperintensities, SLE Disease Activity Index-2000, Systemic Lupus International Collaborating Clinical/ACR Organ Damage Index, or Montgomery Asberg Depression Rate Score Self-report. CONCLUSIONS We found alterations of white matter microstructure in SLE patients that were related to disease duration and fatigue. Our results indicate that cerebral involvement in SLE is not isolated to the NPSLE subgroup.
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Abstract
Cognitive deficits are common in patients with systemic lupus erythematosus (SLE) regardless of overt neuropsychiatric involvement; however, a clear neuropsychological profile of SLE has not emerged. This study undertook a literature search of the PubMed, Scopus and Ovid (PsychINFO) databases for studies investigating cognitive alterations in SLE, using standardized neuropsychological (NP) measures. The data were analysed using meta-analytical procedures. The results support the observation that relative to healthy controls, SLE (regardless of overt neuropsychiatric involvement) is associated with statistically significant, small effect-sized deficits in visual attention, cognitive fluency, immediate visual memory and visual reasoning. Moreover, the results support a gradient of cognitive disturbance in SLE with significantly greater cognitive impairment in NPSLE patients relative to non-NPSLE patients. Medium-sized deficits were observed in NPSLE patients relative to healthy controls across the domains of: complex attention, delayed verbal memory, language and verbal reasoning (with small or non-significant differences observed in non-NPSLE patients relative to healthy controls). These results are relevant to the understanding, assessment and rehabilitation of patients living with SLE, with or without overt neuropsychiatric involvement.
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Affiliation(s)
- B Leslie
- 97586 College of Science Health and Engineering, La Trobe University , School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - S F Crowe
- 97586 College of Science Health and Engineering, La Trobe University , School of Psychology and Public Health, Bundoora, Victoria, Australia
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Butt BA, Farman S, Khan SEA, Saeed MA, Ahmad NM. Cognitive dysfunction in patients with Systemic Lupus Erythematosus. Pak J Med Sci 2017; 33:59-64. [PMID: 28367173 PMCID: PMC5368330 DOI: 10.12669/pjms.331.11947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To determine the frequency of cognitive dysfunction in patients with Systemic Lupus Erythematosus in a Pakistani population, presenting at a tertiary care Rheumatology setting. Methods: This cross-sectional study was conducted at the Division of Rheumatology, Fatima Memorial Hospital, Lahore, from March to June 2016. A total of 43 consecutive patients, who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) classification criteria for Systemic Lupus Erythematosus (SLE), were enrolled. Cognitive function was assessed using Montréal Cognitive Assessment (MoCA) questionnaire. Demographic data and disease dynamics were collected in a proforma. Cognitive dysfunction was defined as score < 26/30, adjusted for duration of formal education. SPSS version 16.0 for windows was used to analyse data and to calculate frequency of cognitive dysfunction. Results: Out of 43 enrolled patients, 95.3% were females and 4.7% were males, with mean age of 28.72 ± 9.25 years and mean formal education duration of 10.98 ± 3.29 years. The mean disease duration was 24.21 ± 30.46 months. Anti-nuclear antibodies (ANA) were present in all patients and anti-ds DNA in 93% patients. Cognitive dysfunction according to MoCA score was found in 65.1% (n=28) patients. For patients with disease duration more than two years, cognitive dysfunction was found in 60% patients [p>0.05] and for duration of formal education less than 12 years in 74.1% patients [p>0.05]. Conclusion: In this study, two third of SLE patients had Cognitive dysfunction. Hence, there is an increasing need to recognise and initiate early therapy for this overlooked aspect of SLE with an aim to achieve better quality of life.
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Affiliation(s)
- Bilal Azeem Butt
- Bilal Azeem Butt, FCPS (Medicine). Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Sumaira Farman
- Sumaira Farman, FRCP, FACP, FACR, SCE Rheumatology. Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Saira Elaine Anwer Khan
- Saira Elaine Anwer Khan, MRCP, SCE Rheumatology. Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Muhammad Ahmed Saeed
- Muhammad Ahmed Saeed, FCPS (Rheumatology) FACR, FCPS (Medicine). Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Nighat Mir Ahmad
- Nighat Mir Ahmad, FACP, FACR, DABR, DABIM. Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
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30
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Yelnik CM, Kozora E, Appenzeller S. Cognitive disorders and antiphospholipid antibodies. Autoimmun Rev 2016; 15:1193-1198. [PMID: 27639839 DOI: 10.1016/j.autrev.2016.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/08/2016] [Indexed: 02/09/2023]
Abstract
Cognitive disorders have frequently been described in the field of antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). Nevertheless, the relationship between those disorders and antiphospholipid antibodies (aPL) remains unclear and seems to involve various mechanisms. Overlap with systemic lupus erythematosus, the small sample size of studies, and discrepancies in antiphospholipid antibodies and cognitive impairment determinations complicate analyses of the literature data. In this paper, we summarize current knowledge on epidemiologic, clinical data, imaging findings and treatment of cognitive dysfunction associated with aPL. We separately analyzed data on aPL-positive carriers without history of clinical feature of APS, APS patients without overlaps autoimmune disease, and SLE-associated aPL patients.
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Affiliation(s)
- Cécile M Yelnik
- Internal Medicine Department, University of Lille, UFR Medicine, Lille, France.
| | - Elizabeth Kozora
- Department of Medicine, National Jewish Health, 1400 Jackson St., Denver, CO 80206, United States; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States; Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Simone Appenzeller
- Department of Medicine, Faculty of Medical Science, State University of Campinas, Campinas, Brazil.
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Montero-López E, Santos-Ruiz A, Navarrete-Navarrete N, Ortego-Centeno N, Pérez-García M, Peralta-Ramírez MI. The effects of corticosteroids on cognitive flexibility and decision-making in women with lupus. Lupus 2016; 25:1470-1478. [PMID: 27055522 DOI: 10.1177/0961203316642313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the possible effects of corticosteroids in women with systemic lupus erythematosus (SLE) in two processes of executive function: cognitive flexibility and decision-making. To that end, we evaluated 121 women divided into three groups: 50 healthy women, 38 women with SLE not receiving corticosteroid treatment and 33 women with SLE receiving corticosteroid treatment. Cognitive flexibility was measured with the Trail Making Tests A and B; decision-making was measured with the Iowa Gambling Task. Additionally, demographic (age and education level), clinical (SLE Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) and disease duration) and psychological characteristics (stress vulnerability, perceived stress and psychopathic symptomatology) were evaluated. The results showed that both SLE groups displayed poorer decision-making than the healthy women ( p = 0.006) and also that the SLE group receiving corticosteroid treatment showed lower cognitive flexibility than the other two groups ( p = 0.030). Moreover, SLE patients showed poorer scores than healthy women on the following SCL-90-R subscales: somatisation ( p = 0.005), obsessions and compulsions ( p = 0.045), depression ( p = 0.004), hostility ( p = 0.013), phobic anxiety ( p = 0.005), psychoticism ( p = 0.016) and positive symptom total ( p = 0.001). In addition, both SLE groups were more vulnerable to stress ( p = 0.000). These findings help to understand the effects of corticosteroid treatment on cognitive flexibility and decision-making, in addition to the disease-specific effects suffered by women with SLE.
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Affiliation(s)
- E Montero-López
- 1 Department of Clinical Psychology, University of Granada, Granada, Spain
| | - A Santos-Ruiz
- 2 Department of Health Psychology, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - N Navarrete-Navarrete
- 3 Systemic Autoimmune Disease Unit, Internal Medicine Service, Virgen de las Nieves University Hospital, Granada, Spain
| | - N Ortego-Centeno
- 4 Systemic Autoimmune Disease Unit, Internal Medicine Service, San Cecilio Clinical Hospital, Granada, Spain
| | - M Pérez-García
- 1 Department of Clinical Psychology, University of Granada, Granada, Spain.,5 Mind, Brain and Behavior Research Centre (CIMCYC). Granada, Spain
| | - M I Peralta-Ramírez
- 1 Department of Clinical Psychology, University of Granada, Granada, Spain.,5 Mind, Brain and Behavior Research Centre (CIMCYC). Granada, Spain
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33
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Conti F, Ceccarelli F, Perricone C, Leccese I, Massaro L, Pacucci VA, Truglia S, Miranda F, Spinelli FR, Alessandri C, Valesini G. The chronic damage in systemic lupus erythematosus is driven by flares, glucocorticoids and antiphospholipid antibodies: results from a monocentric cohort. Lupus 2016; 25:719-26. [PMID: 26821965 DOI: 10.1177/0961203315627199] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Literature data suggest a significantly higher mortality in patients affected by systemic lupus erythematosus (SLE) developing chronic damage. Therefore, damage prevention is a major goal in the management of SLE patients. In the present study, we assessed damage by means of the Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI), in a large cohort of SLE patients. Additionally, we aimed at evaluating its association with demographic and clinical features as well as with disease activity and laboratory findings. PATIENTS AND METHODS We enrolled consecutive patients affected by SLE diagnosed according to the American College of Rheumatology (ACR) 1997 revised criteria. Chronic damage was determined by SDI calculated at the last examination in all patients with at least six months of follow-up. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K); flare was defined as an increase of SLEDAI-2K ≥ 4 compared with the previous visit. RESULTS We evaluated 349 SLE patients (M/F 25/324, mean age ± SD 42.7 ± 12.4 years, mean disease duration ± SD 164.9 ± 105.2 months). Among the enrolled patients, 125 (35.8%) showed a SDI ≥ 1 (mean SDI ± SD 1.7 ± 0.9, range 0-5). The musculo-skeletal was the most frequently involved organ/system in SDI score (41/349 patients, 11.7%), with deforming/erosive arthritis in 21/349 (6.0%). The presence of chronic damage was associated with age (P < 0.001), disease duration (P < 0.001), number of flares (P = 0.02) and with the use of glucocorticoids (P = 0.02). The logistic regression analysis revealed the association between neuropsychiatric damage and antiphospholipid syndrome (P = 0.01, OR = 3.9) and between the presence of cardiovascular damage and anti-β2GPI antibodies (P = 0.01, OR 6.2). CONCLUSIONS In the present study chronic damage was identified in about one third of SLE patients. The association between SDI and the number of flares claim for a thigh-control of the disease activity in order to prevent the chronic damage. The possible role of antiphospholipid antibodies (aPL) in the development of neuropsychiatric and cardiovascular damage may suggest a more careful assessment of such aPL positive patients.
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Affiliation(s)
- F Conti
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - F Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - C Perricone
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - I Leccese
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - L Massaro
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - V A Pacucci
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - S Truglia
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - F Miranda
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - F R Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - C Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - G Valesini
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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Luggen ME, Gulati G, Zhang B, Willis RA, Gonzalez EB. Non-criteria anti-phospholipid antibodies and cognitive impairment in SLE. Clin Rheumatol 2015; 35:93-9. [DOI: 10.1007/s10067-015-3114-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/01/2022]
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Barraclough M, Elliott R, McKie S, Parker B, Bruce IN. Cognitive dysfunction and functional magnetic resonance imaging in systemic lupus erythematosus. Lupus 2015; 24:1239-47. [PMID: 26124237 DOI: 10.1177/0961203315593819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/05/2015] [Indexed: 01/04/2023]
Abstract
Cognitive dysfunction is a common aspect of systemic lupus erythematosus (SLE) and is increasingly reported as a problem by patients. In many cases the exact cause is unclear. Limited correlations between specific autoantibodies or structural brain abnormalities and cognitive dysfunction in SLE have been reported. It may be that the most appropriate biomarkers have yet to be found. Functional magnetic resonance imaging (fMRI) is a technique used in many other conditions and provides sensitive measures of brain functionality during cognitive tasks. It is now beginning to be employed in SLE studies. These studies have shown that patients with SLE often perform similarly to healthy controls in terms of behavioural measures on cognitive tasks. However, SLE patients appear to employ compensatory brain mechanisms, such as increased response in fronto-parietal regions, to maintain adequate cognitive performance. As there have been only a few studies using fMRI in SLE to investigate cognitive dysfunction, many questions remain unanswered. Further research could, however, help to identify biomarkers for cognitive dysfunction in SLE.
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Affiliation(s)
- M Barraclough
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - R Elliott
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK Neuroscience and Psychiatry Unit, Institute of Brain and Behaviour and Mental Health, The University of Manchester, UK and Manchester Academic Health Science Centre
| | - S McKie
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK Neuroscience and Psychiatry Unit, Institute of Brain and Behaviour and Mental Health, The University of Manchester, UK and Manchester Academic Health Science Centre
| | - B Parker
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - I N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
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Ceccarelli F, Perricone C, Massaro L, Cipriano E, Alessandri C, Spinelli FR, Valesini G, Conti F. Assessment of disease activity in Systemic Lupus Erythematosus: Lights and shadows. Autoimmun Rev 2015; 14:601-8. [PMID: 25742757 DOI: 10.1016/j.autrev.2015.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/24/2015] [Indexed: 01/24/2023]
Abstract
The assessment of disease activity in patients affected by Systemic Lupus Erythematosus (SLE) represents an important issue, as recommended by the European League Against Rheumatism (EULAR). Two main types of disease activity measure have been proposed: the global score systems, providing an overall measure of activity, and the individual organ/system assessment scales, assessing disease activity in different organs. All the activity indices included both clinical and laboratory items, related to the disease manifestations. However, there is no gold standard to measure disease activity in patients affected by SLE. In this review, we will analyze the lights and shadows of the disease activity indices, by means of a critical approach. In particular, we will focus on SLE Disease Activity Index (SLEDAI) and British Isles Lupus Assessment Group (BILAG), the most frequently used in randomized controlled trials and observational studies. The evaluation of data from the literature underlined some limitations of these indices, making their application in clinical practice difficult and suggesting the possible use of specific tools in the different subset of SLE patients, in order to capture all the disease features.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy.
| | - Carlo Perricone
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Laura Massaro
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Enrica Cipriano
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Guido Valesini
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e specialità Mediche, Sapienza Università di Roma, Italy
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Nishimura K, Omori M, Katsumata Y, Sato E, Gono T, Kawaguchi Y, Harigai M, Mimura M, Yamanaka H, Ishigooka J. Neurocognitive impairment in corticosteroid-naive patients with active systemic lupus erythematosus: a prospective study. J Rheumatol 2015; 42:441-8. [PMID: 25593228 DOI: 10.3899/jrheum.140659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Neurocognitive impairment (NCI) has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which may itself induce NCI. We investigated NCI in corticosteroid-naive people with SLE who did not exhibit any overt neuropsychiatric manifestations. METHODS Forty-three inpatients with SLE who had no current or past neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic characteristics were given a 1-h battery of neuropsychological tests. NCI was defined as scores at least 2 SD below the mean of the healthy control group on at least 2 of the 7 neurocognitive domains. Results of clinical, laboratory, and neurologic tests were compared regarding the presence of NCI. RESULTS NCI was identified in 12 patients (27.9%) with SLE and in 2 control subjects (6.7%). Patients with SLE showed a significant impairment compared with controls on tasks assessing immediate recall, complex attention/executive function, and psychomotor speed. We identified psychomotor speed (Digit Symbol Substitution Test) as the factor that best differentiated the 2 groups. Further, we identified the score of the SLE Disease Activity Index 2000 as an independent risk factor for NCI in patients with SLE. CONCLUSION We conclude that reduced psychomotor speed is an SLE-specific pattern of NCI. Verbal-memory deficits that have been reported in patients with SLE were not evident among patients who were corticosteroid-naive. Our results indicate that impaired psychomotor speed may be added to the symptoms of early SLE.
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Affiliation(s)
- Katsuji Nishimura
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
| | - Masako Omori
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Yasuhiro Katsumata
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Eri Sato
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Takahisa Gono
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Yasushi Kawaguchi
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Masayoshi Harigai
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Masaru Mimura
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Hisashi Yamanaka
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Jun Ishigooka
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
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Mycophenolate mofetil in systemic lupus erythematosus: results from a retrospective study in a large monocentric cohort and review of the literature. Immunol Res 2014; 60:270-6. [DOI: 10.1007/s12026-014-8609-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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40
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Conti F, Ceccarelli F, Gigante A, Barbano B, Perricone C, Massaro L, Martinelli F, Spinelli FR, Giannakakis K, Valesini G, Cianci R. Ultrasonographic evaluation of renal resistive index in patients with lupus nephritis: correlation with histologic findings. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2573-2580. [PMID: 25220271 DOI: 10.1016/j.ultrasmedbio.2014.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/28/2014] [Accepted: 06/23/2014] [Indexed: 06/03/2023]
Abstract
We analyzed the association between the renal arterial resistive index (RI) and the histologic features of lupus nephritis. All consecutive patients with systemic lupus erythematosus (SLE) who required a kidney biopsy were enrolled. The study protocol included ultrasonographic assessment to measure the RI and kidney biopsy (International Society of Nephrology/Renal Pathology Society classification). A RI > 0.7 was considered pathologic. Patients with non-renal SLE and healthy patients were studied as control groups. We enrolled 42 patients with renal SLE, 10 with non-renal SLE and 14 healthy patients: their mean (±standard deviation) RI values were 0.64 ± 0.08, 0.60 ± 0.04 and 0.59 ± 0.01, respectively (p = not significant). RIs > 0.7 were recorded only in patients with renal SLE (5/42, 11.9%). The percentage of patients with a pathologic RI was significantly higher in class IV nephritis in comparison with other classes (p < 0.009). In conclusion, we found a significant correlation between pathologic RI and class IV nephritis, suggesting a role for RI as a severity marker.
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Affiliation(s)
- Fabrizio Conti
- Lupus Clinic, Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy.
| | - Fulvia Ceccarelli
- Lupus Clinic, Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Biagio Barbano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Perricone
- Lupus Clinic, Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Laura Massaro
- Lupus Clinic, Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Francesco Martinelli
- Lupus Clinic, Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | | | - Guido Valesini
- Lupus Clinic, Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza University of Rome, Rome, Italy
| | - Rosario Cianci
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Massardo L, Bravo-Zehnder M, Calderón J, Flores P, Padilla O, Aguirre JM, Scoriels L, González A. Anti-N-methyl-D-aspartate receptor and anti-ribosomal-P autoantibodies contribute to cognitive dysfunction in systemic lupus erythematosus. Lupus 2014; 24:558-68. [DOI: 10.1177/0961203314555538] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/23/2014] [Indexed: 12/28/2022]
Abstract
Objective Autoantibodies against N-methyl-D-aspartate receptor (anti-NMDAR) and ribosomal-P (anti-P) antigens are potential pathogenic factors in the frequently observed diffuse brain dysfunctions in patients with systemic lupus erythematosus (SLE). Although studies have been conducted in this area, the role of anti-NMDAR antibodies in SLE cognitive dysfunction remains elusive. Moreover, the specific contribution of anti-P antibodies has not been reported yet. The present study attempts to clarify the contribution of anti-NMDAR and anti-P antibodies to cognitive dysfunction in SLE. Methods The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess a wide range of cognitive function areas in 133 Chilean women with SLE. ANCOVA models included autoantibodies, patient and disease features. Results Cognitive deficit was found in 20%. Higher SLEDAI-2K scores were associated with impairment in spatial memory and learning abilities, whereas both anti-NMDAR and anti-P antibodies contributed to deficits in attention and spatial planning abilities, which reflect fronto-parietal cortex dysfunctions. Conclusions These results reveal an association of active disease together with specific circulating autoantibodies, such as anti-NMDAR and anti-P, with cognitive dysfunction in SLE patients.
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Affiliation(s)
- L Massardo
- Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina
| | - M Bravo-Zehnder
- Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina
- Centro de Envejecimiento y Regeneración, Departamento de Biología Celular y Molecular, Facultad de Ciencias Biológicas
| | | | | | - O Padilla
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - L Scoriels
- Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Brazil
| | - A González
- Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina
- Centro de Envejecimiento y Regeneración, Departamento de Biología Celular y Molecular, Facultad de Ciencias Biológicas
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Conti F, Spinelli FR, Colafrancesco S, Truglia S, Ceccarelli F, Fattapposta F, Sorice M, Capozzi A, Ferretti G, Priori R, Martinelli F, Pirone C, Alessandri C, Valesini G. Acute longitudinal myelitis following Cryptococcus laurentii pneumonia in a patient with systemic lupus erythematosus. Lupus 2014; 24:94-7. [DOI: 10.1177/0961203314554848] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central nervous system (CNS) involvement in systemic lupus erythematosus (SLE) is reported in about 50% of patients. Among the neuropsychiatric features of SLE, myelopathy, including acute transverse myelitis (ATM) or acute longitudinal myelitis (ALM), represents an uncommon event. A possible vascular aetiology of SLE myelopathies has been hypothesized and it seems to be much more associated to SLE-associated antiphospholipid syndrome (APS). Furthermore, a possible infectious cause of ATM or ALM in healthy subjects has been described. SLE patients are susceptible to infection due to the disease itself or to the immunosuppressive therapy. Cryptococci non-neoformans have been rarely associated to infections in humans. Here we describe the case of a 47-year-old woman with SLE and Sjögren Syndrome who developed an ALM concurrently with a Cryptococcus laurentii pneumonia. The patient was treated with antimycotics, high doses of glucocorticoids and intravenous immunoglobulins with a significant clinical and radiological improvement. As far as we know, this is the first case of Cryptococcus laurentii infection and ALM in a patient with SLE who later developed a seronegative APS. Even though myelopathy may be considered primarily associated to SLE, a possible role of the infection in ALM development cannot be excluded.
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Affiliation(s)
- F Conti
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - F R Spinelli
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - S Colafrancesco
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - S Truglia
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - F Ceccarelli
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - F Fattapposta
- Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma, Rome, Italy
| | - M Sorice
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - A Capozzi
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - G Ferretti
- Dipartimento di Malattie Infettive e Tropicali, Sapienza Università di Roma, Rome, Italy
| | - R Priori
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - F Martinelli
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - C Pirone
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - C Alessandri
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
| | - G Valesini
- Dipartimento di Medicina Interna e Specialità Mediche – Reumatologia; Sapienza Università di Roma, Rome, Italy
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Immediate and Long-term Neurocognitive Outcome in Patients with Obstructive Sleep Apnea Syndrome After Continuous Positive Airway Pressure Treatment. Indian J Otolaryngol Head Neck Surg 2014; 67:79-85. [PMID: 25621259 DOI: 10.1007/s12070-014-0777-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/13/2014] [Indexed: 02/03/2023] Open
Abstract
Neurocognitive dysfunction is a major clinical consequence in patients with obstructive sleep apnea syndrome (OSAS). The effects of continuous positive airway pressure (CPAP) treatment, as the gold standard of treatment in OSAS, on this major complication are controversial. The duration and compliance of CPAP are thought to be important factors but evidence is lacking. This study is designed to evaluate the effects of immediate (one night), long-term (3 months) influence and the compliances of CPAP treatment on the neurocognitive function in OSAS patients. We enrolled newly diagnosed severe OSAS patients. Neurocognitive function test battery, CANTAB (Cambridge Neuropsychological Test Automated Battery), was performed before, one night and 3 months of CPAP treatment. Patients with CPAP compliance rate ≥ 70 % and < 50 % were grouped into good and poor adherence subjects, respectively. Fourteen patients were enrolled in final analyses. Six of them were in poor compliant group. Improvements in attention domain were found in all subjects after one-night treatment and maintained till three-month follow-up. Additional improvements in some attention performances and visual memory performances were gained only after three-month treatment. Significant changes of decision-making and response control function were found between good and poor compliance groups after three-month treatment. CPAP can improve some neurocognitive function at the very first day used. Longer treatment of CPAP can additionally improve some other neurocognitive functions. Compliance of CPAP has influence on the recovery of neurocognitive functions in patients with severe OSAS.
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Perricone C, Shoenfeld N, Agmon-Levin N, de Carolis C, Perricone R, Shoenfeld Y. Smell and autoimmunity: a comprehensive review. Clin Rev Allergy Immunol 2014; 45:87-96. [PMID: 23233263 DOI: 10.1007/s12016-012-8343-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The sense of smell is an ancient sensory modality vital for sampling and perceiving the chemical composition of surrounding environments. Olfaction involves a pathway of biochemical and electrophysiological processes, which allows the conversion of molecular information into sensations. Disturbances in the olfactory function have been investigated mainly in neurological/neurodegenerative disorders such as Alzheimer's and Parkinson's diseases; impaired sense of smell has been associated with depressed mood. Only recently, smell capability was tested in other diseases, particularly autoimmune diseases. Shoenfeld and colleagues opened this chapter showing that patients affected with systemic lupus erythematosus (SLE) have disturbances in their olfactory functions and revealed its association with neuropsychiatric manifestations of the disease. This evidence was confirmed in experimental models and replicated in other SLE populations. The connection between autoimmunity and the sense of smell was lately emphasized by studies on patients with Sjögren's syndrome and in patients with other autoimmune/immune-mediated diseases, such as polydermatomyositis, recurrent spontaneous abortion, and hereditary angioedema. Genetic susceptibility and hormonal and environmental factors may play a role in these conditions. Olfactory receptor gene clusters are located in proximity to key locus of susceptibility for autoimmune diseases such as the major histocompatibility complex, suggesting not only a physic linkage, but a functional association. Nonetheless, gender- and hormone-mediated effects are fundamental in the development of autoimmune diseases. The different connections between smell and autoimmunity, genes and hormones may suggest that this is another tessera of a mosaic which is waiting the answer of Oedipus.
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Affiliation(s)
- Carlo Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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Abstract
PURPOSE OF REVIEW Neuropsychiatric manifestations pose diagnostic and therapeutic challenges in systemic lupus erythematosus (SLE). We review recently published studies on the epidemiology, pathogenesis, neuroimaging, and treatment of NPSLE. RECENT FINDINGS Generalized SLE activity or damage and antiphospholipid antibodies are identified as major risk factors for neuropsychiatric involvement. NPSLE patients have increased genetic burden and novel genomic approaches are expected to elucidate its pathogenesis. Animal data suggest that, in cases of disturbed blood-brain barrier, autoantibodies against the NR2 subunits of the N-methyl-D-aspartate receptor and 16/6 idiotype antibodies may cause diffuse neuropsychiatric manifestations through neuronal apoptosis or brain inflammation; data in humans are still circumstantial. In NPSLE, advanced neuroimaging uncovers structural and metabolic abnormalities in brain regions with normal appearance on conventional MRI. Treatment includes corticosteroids/immunosuppressants for inflammatory manifestations or generalized SLE activity, and antiplatelets/anticoagulation for manifestations related to antiphospholipid antibodies. In refractory cases, uncontrolled studies suggest a beneficial role of rituximab. SUMMARY We have begun to better understand how brain-reactive autoantibodies, present in a proportion of SLE patients, can cause brain injury and diffuse NPSLE. Further testing will be required to determine the clinical utility of advanced neuroimaging. Controlled trials are needed to guide therapeutic decisions.
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Conti F, Perricone C, Reboldi G, Gawlicki M, Bartosiewicz I, Pacucci VA, Massaro L, Miranda F, Truglia S, Alessandri C, Spinelli FR, Teh LS, Ceccarelli F, Valesini G. Validation of a disease-specific health-related quality of life measure in adult Italian patients with systemic lupus erythematosus: LupusQoL-IT. Lupus 2014; 23:743-51. [PMID: 24569393 DOI: 10.1177/0961203314524466] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/28/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this paper is to assess the validity of a linguistically validated version of the Lupus Quality of Life (LupusQoL(©)) in Italian patients affected by systemic lupus erythematosus (SLE). METHODS Consecutive SLE patients completed the Italian version of the LupusQoL(©) and the Short Form (SF)-36. Disease activity was evaluated by the SLE disease activity Index-2000 (SLEDAI-2 K), and chronic damage by the Systemic Lupus International Collaborating Clinics/American College Rheumatology (ACR) Damage Index score (SDI). Internal consistency and test-retest reliability, convergent and discriminant validity were examined. Factor analysis with varimax rotation was performed. RESULTS A total of 117 Italian SLE patients (M:F 13:104; mean age 40.6 ± 11.6 years, mean disease duration 127.5 ± 94.1 months) were recruited into the study. The Italian version of the LupusQoL(©) demonstrated substantial evidence of convergent validity in these patients when compared with equivalent items of the SF-36. In addition, the LupusQoL(©) discriminated between patients with different degrees of disease activity as measured by the SLEDAI-2 K. SLE patients with higher disease activity (SLEDAI-2K ≥4) showed poor QoL compared with those with lower disease activity (SLEDAI-2K <4), with significant differences in the domains of physical health, planning, burden to others and fatigue (p = 0.001, p = 0.04, p = 0.03, p = 0.04, respectively). The confirmatory factor analysis using the eight domain loadings of the 34 items showed a poor fit (χ(2)/degree of freedom (df) 2.26, χ(2 )= 1128.6 (p < 0.001), root mean square error of approximation (RMSEA) = 0.167; goodness-of-fit index (GFI) = 0.606, comparative fit index (CFI) = 0.649)). Screeplot analysis suggested a five-factor loading structure and confirmatory factor analysis result of which is similar to the eight-factor model. A good internal consistency was observed (Cronbach's α 0.89-0.91). Test-retest reliability was good to excellent between baseline and day 15 (intraclass correlation coefficient (ICC) 0.90-0.98). CONCLUSION The Italian version of the LupusQoL(©) is a valid tool for adult patients with SLE.
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Affiliation(s)
- F Conti
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - C Perricone
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - G Reboldi
- Department of Medicine, University of Perugia, Perugia, Italy
| | - M Gawlicki
- Corporate Translations, Inc., East Hartford, CT, USA
| | - I Bartosiewicz
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - V A Pacucci
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - L Massaro
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - F Miranda
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - S Truglia
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - C Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - F R Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - L-S Teh
- Department of Rheumatology, Royal Blackburn Hospital, Blackburn, UK
| | - F Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - G Valesini
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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High prevalence of antinuclear antibodies in children with thyroid autoimmunity. J Immunol Res 2014; 2014:150239. [PMID: 24741574 PMCID: PMC3987791 DOI: 10.1155/2014/150239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antinuclear antibodies (ANA) are a hallmark of many autoimmune diseases and can be detected many years before disease onset. Autoimmune thyroid diseases (AITD) are frequently associated with other organ- and non-organ-specific autoimmune disorders. Objectives. To assess the prevalence of ANA in pediatric patients with AITD and their clinical correlations. METHODS Ninety-three consecutive pediatric patients with AITD were enrolled (86 children with chronic lymphocytic thyroiditis and 7 with Graves' disease). ANA, anti-double DNA (anti-dsDNA) antibodies, anti-extractable nuclear antigen (anti-ENA), anti-cyclic citrullinated peptide antibodies (anti-CCP), and rheumatoid factor (RF) was obtained. Signs and symptoms potentially related to rheumatic diseases in children were investigated by a questionnaire. RESULTS ANA positivity was found in 66/93 children (71%), anti-ENA in 4/93 (4.3%), anti-dsDNA in 1/93 (1.1%), RF in 3/93 (3.2%), and anti-CCP in none. No significant differences were found between the ANA-positive and ANA-negative groups with respect to age, sex, L-thyroxine treatment, or prevalence of other autoimmune diseases. Overall, parental autoimmunity was found in 23%. CONCLUSIONS ANA positivity was demonstrated in 71% of children with AITD. ANA positivity was not related to overt immune-rheumatic diseases. However, because the positivity of ANA can occur even many years before the onset of systemic autoimmune diseases, prospective studies are warranted.
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Conti F, Spinelli FR, Alessandri C, Pacelli M, Ceccarelli F, Marocchi E, Montali A, Capozzi A, Buttari B, Profumo E, Sorice M, Arca M, Valesini G, Riganò R. Subclinical atherosclerosis in systemic lupus erythematosus and antiphospholipid syndrome: focus on β2GPI-specific T cell response. Arterioscler Thromb Vasc Biol 2014; 34:661-8. [PMID: 24436371 DOI: 10.1161/atvbaha.113.302680] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Systemic Lupus Erythematosus (SLE) and antiphospholipid syndrome (APS) are associated with a high prevalence of atherosclerosis. β2 glycoprotein I (β2GPI) represents a link between autoimmunity and endothelial dysfunction. Recently, β2GPI reactive T cells have been identified; however, their role in atherosclerosis is still under investigation. We evaluated early atherosclerosis in patients with SLE and APS and investigated T cell reactivity to β2GPI and its relationship with atherosclerotic process. APPROACH AND RESULTS Fifty SLE, 18 patients with primary APS (PAPS), and 25 healthy controls were enrolled. Demographic and clinical data, including traditional cardiovascular risk factors, were recorded. Monocyte β2GPI and Tissue Factor (TF) expression and peripheral blood mononuclear cell response to β2GPI stimulation were evaluated. Doppler ultrasound was performed to investigate flow-mediated dilatation (FMD) and carotid intima-media thickness (IMT). We detected an increase in mean IMT and a decrease in FMD in patients with SLE versus controls (P<0.05 and P=0.0001, respectively) and a decrease in FMD in patients with PAPS versus controls (P<0.05). Monocyte β2GPI and TF expression was higher in patients with SLE and PAPS than in controls (P=0.006 and P=0.001, respectively); no correlation of monocyte β2GPI and TF with IMT or FMD was detected. β2GPI induced peripheral blood mononuclear cell proliferation in 32% of patients with SLE, 25% of patients with PAPS yet in none of the controls. Proliferative response to β2GPI correlated with a history of arterial thrombosis, thrombocytopenia, and IMT >0.9 mm. CONCLUSIONS A significant percentage of patients with SLE and PAPS show a β2GPI-specific T cell reactivity, which is associated with subclinical atherosclerosis.
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Affiliation(s)
- Fabrizio Conti
- From the Rheumatology Unit (F.C., F.R.S., C.A., F.C., E.M., G.V.), Atherosclerosis Unit (A.M., M.A.), and Internal Medicine D (M.P.), Department of Internal Medicine and Medical Specialties and Department of Experimental Medicine (A.C., M.S.), Sapienza University of Rome, Rome, Italy; and Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy (B.B., E.P., R.R.)
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Conti F, Alessandri C, Spinelli FR, Capozzi A, Martinelli F, Recalchi S, Misasi R, Valesini G, Sorice M. TLC immunostaining for detection of "antiphospholipid" antibodies. Methods Mol Biol 2014; 1134:95-101. [PMID: 24497357 DOI: 10.1007/978-1-4939-0326-9_8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Thin-layer chromatography (TLC) is a nonquantitative technique, which has been employed in the detection of antiphospholipid (aPL) antibodies. Antiphospholipid syndrome (APS) is the most frequently acquired thrombophilia, characterized by thrombosis and obstetric manifestations associated to an autoimmune trait, represented by the positivity of antiphospholipid (aPL) antibodies. Immunoassays for anticardiolipin (aCL) and anti-β2 glycoprotein I (aβ2GPI) antibodies and clotting tests for lupus anticoagulant (LA) represent the standard tests for the routine detection of aPL. The term "seronegative APS" has been used to describe patients with clinical manifestation of APS and persistently negative aPL assessed with routine assays. TLC immunostaining is a useful method for the detection of different antigenic targets of "antiphospholipid" antibodies; it is able to identify the reactivity of serum aPL experimented with purified phospholipid molecules with a different exposure compared to ELISA methods. This method seems to be applicable in patients who repeatedly tested negative for the standard aPL, i.e., aCL, aβ2GPI, and LA. Therefore, this technique may be proposed as a second step test for the diagnosis of APS.
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Affiliation(s)
- Fabrizio Conti
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy
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Iagnocco A, Ceccarelli F, Rizzo C, Truglia S, Massaro L, Spinelli FR, Vavala C, Valesini G, Conti F. Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus. Rheumatology (Oxford) 2013; 53:465-72. [PMID: 24231444 DOI: 10.1093/rheumatology/ket376] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the prevalence and severity of inflammatory abnormalities of the hand, wrist and foot joints in SLE patients by US and to correlate them with clinical, laboratory and disease activity score parameters. METHODS Sixty-two consecutive SLE patients were enrolled in the present study and underwent clinical evaluation, laboratory tests and bilateral high-resolution US of the hand, wrist and foot joints. Joint effusion (JE), synovial hypertrophy (SH) and local pathological vascularization [power Doppler (PD)] were evaluated according to both a dichotomous score and a semi-quantitative (0-3) grading system. In addition, a global US score was calculated by summing the values given to each elementary lesion for every single joint and every joint group. US findings were correlated with physical examination, serological parameters (CRP, ANA, anti-dsDNA, ENA, aPL, C3 and C4 serum levels) and disease activity indexes (SLEDAI-2K, ECLAM). RESULTS US detected inflammatory joint abnormalities in 54/62 patients (87.1%); 72.6% presented involvement of the MTP joints, 46.7% the MCP joints, 19.3% the PIP joints and 53% the wrists. A total of 1984 joints were examined highlighting JE in 19.1% of cases, SH in 6.9% and positive PD in 1.1%. The global US inflammatory score had a mean value of 10.9 (s.d. 15.2). No correlations were found between US findings and SLE disease activity parameters. CONCLUSION US demonstrated a high prevalence of inflammatory joint abnormalities in SLE that were also present in asymptomatic patients. Interestingly, the foot joints were the most frequently involved. US is a valuable tool for detecting subclinical synovitis in SLE.
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Affiliation(s)
- Annamaria Iagnocco
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Viale del Policlinico 155, Rome 00161, Italy.
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