Neuropsychiatric Manifestations in Egyptian Systemic Lupus Erythematosus Patients

Document Type : Original Article


The Department of Rheumatology & Rehabilitation, Faculty of Medicine, Beni Suef University1, Department of Internal Medicine, National Research Centre2, Department of Rheumatology & Rehabilitation, Military Medical Academy3, Department Internal Medicine, Faculty of Medicine, Cairo University4 and Department of Rheumatology & Rehabilitation, Faculty of Medicine, Cairo University5


Abstract Background: Neuropsychiatric Systemic lupus erythema-tosus (NPSLE) is a complex condition that remains poorly understood, and includes heterogeneous manifestations in-volving both the central and peripheral nervous system, with disabling effects. Aim of Study: This study was to investigate the frequency and association of NPSLE in a group of Egyptian Systemic lupus erythematosus (SLE) patients. Patients and Methods: This study retrospectively reviewed the medical records of 198 SLE patients. Ten Neuropsychiatric (NP) manifestations were reported from patient's medical records: Headache, psychosis, seizures, transient ischemic attacks (TIAs), stroke, transverse myelitis, cognitive dysfunc-tion, chorea, cranial neuropathy and peripheral neuropathy. Patients were divided according to the presence or absence of the previously mentioned ten manifestations into two group. The two groups were compared regarding clinical, laboratory, treatment options, Systemic Lupus Erythematosus Disease Activity Index(SLEDAI) and Systemic Lupus International Collaborative clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) indices. Results: The mean disease duration in our patients was 8.33±6.17 years. Eighty-seven (43.0%) patients had NP manifestations. The most common SLE manifestations were headache (31.8%) followed by epilepsy (9.1%) and psychosis (8.1%). Other NPSLE syndromes observed in the study are peripheral nerve affection (7.1%), cognitive Involvement (4%), stroke (3.5%),TIAs (2.5%). The least common NPSLE manifestation were transverse myelitis, chorea and cranial nerve affection, each (0.5%). SLEDAI at onset, SLEDAI at last visit and SLICC DI were statistically significantly (p<0.001, p<0.001 and p<0.005 respectively). Patients with NPSLE showed higher intravenous pulse methylprednisolone intake (p<0.042) and higher cumulative intravenous methyl-prednisolone dose (p<0.001).
Conclusion: Frequency of NPSLE in our cohort was (43.0%), headache, seizures and psychosis were the most frequent NP manifestations in the studied patients, patients with NPSLE showed higher SLEDAI both (at onset and in last reported visit), higher SLICC damage index, and higher intake and cumulative dose in pulse methyl prednisolone.