Clinical and laboratory manifestations of systemic lupus erythematosus in patients with neuropsychiatric disorders (eurasian renaissance register)

Abstract

Objective: to investigate the clinical and laboratory manifestations of systemic lupus erythematosus (SLE) with nervous system lesions in a Kyrgyz cohort.Subjects and methods. The prospective study enrolled 460 patients with SLE who fulfilled American College of Rheumatology (ACR) 1987 and SLICC 2012 criteria, and had been followed up at Academician M. Mirrahimov National Center for Cardiology and Therapy, from January 2012 to December 2017 according to the Eurasian RENAISSANCE Register program. The 1999 ACR classification criteria were used to evaluate the neuropsychiatric manifestations of SLE (NPSLE). A psychiatrist diagnosed neuropsychiatric disorders according to the ICD-10. A psychologist identified cognitive impairment, by using the specific Mini-Mental State Examination (MMSE) (a minischeme for examining a patient's mental status).Results and discussion. Various NPSLEs were detected in 103 (22.39%) of the 460 patients. According to the 1999 ACR criteria, 103 patients were diagnosed as having 155 different NPSLEs, including 123 (79.35%) patients who had central nervous system (CNS) disorders and 32 (20.65%) with peripheral nervous system (PNS) damages. There were 76 (61.79%) focal 47 (38.21%) diffuse CNS disorders. Most patients with diffuse NPSLEs were observed to have psychosis, the main manifestations of which were visual and auditory hallucinations (72.34%). The patients with focal NPSLEs had cerebrovascular disease (43.42%) with increase of level of antinuclear antibodies, antibodies against double-stranded DNA and hypocomplementemia (95.56, 86.52, and 73.85%, respectively). Patients with CNS lesions were significantly more likely than those with PNS to have lupus nephritis and hematological disorders (leukopenia, lymphopenia, and thrombocytopenia), as well as high immunological activity.Conclusion. Most patients with diffuse NPSLEs were observed to have psychosis with visual and auditory hallucinations (72.34%), and those with focal NPSLEs had cerebrovascular disease (43.42%) with a high frequency of immunological disorders. Lupus nephritis and hematological disorders with high immunological activity were significantly more common in patients with CNS lesions than in those with PNS ones.

Keywords

• systemic lupus erythematosus
• neuropsychiatric manifestations
• central nervous system
• peripheral nervous system
• kyrgyz cohort