Antinuclear antibodies testing as a routine screening for systemic lupus erythematosus in patients presenting first‐episode psychosis

Mantovani, Célia; Louzada‐Júnior, Paulo; Nunes, Emerson Arcoverde; Figueiredo, Felipe Pinheiro de; Oliveira, G. R. De; Del-Ben, Cristina Marta

doi:10.1111/j.1751-7893.2011.00339.x

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…While previous studies have shown the prevalence of neuropsychiatric events in patients with established SLE (4), there is a paucity of data regarding the use of testing for ANAs to screen for NPSLE in patients with psychosis (6,7) or the significance of a positive test. Our study demonstrates the prevalence of NSPLE in a group of selected inpatients with psychosis and ANA positivity to be <2%.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there is limited evidence to support or refute the use of ANA testing to screen for SLE or connective tissue disease in patients with psychosis. In a retrospective study of 85 patients with psychosis who were tested for ANAs, Mantovani and colleagues found that 3 patients were ANA positive, 2 of whom were diagnosed and treated for NPSLE (6). A prospective study by Audemard-Verger et al of 100 patients found no episodes of NPSLE among 32 ANA-positive patients in a more heterogeneous group of mental health disorders (7).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Neuropsychiatric Lupus in Psychosis Patients Who Have Tested Positive for Antinuclear Antibodies

Spies

Gutjahr-Holland

Bertouch

et al. 2022

Arthritis Care & Research

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Objective. Psychosis is a rare manifestation of neuropsychiatric systemic lupus erythematosus (NPSLE). Current guidelines do not make a recommendation regarding the use of antinuclear antibody (ANA) testing in the assessment of patients with psychosis. The present study was undertaken to determine the prevalence of NPSLE in patients with psychosis who were positive for ANAs.Methods. A retrospective review of patients who were admitted to the mental health service of 2 metropolitan tertiary referral centers with a diagnosis of psychosis and had been tested for ANAs was conducted. A diagnosis of SLE was made when the 2019 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria were fulfilled. Attribution of psychosis-related events to NPSLE were made according to validated criteria.Results. There were 10,205 mental health admissions with diagnoses of psychosis representing 4,766 individual patients, 911 patients (19%) were tested for ANAs, 135 (15%) of those tests returned a positive result with a titer of ≥1:160. The mean AE SD follow-up time was 47 AE 26 months. At discharge, there were 4 patients who met 2019 ACR/EULAR criteria for SLE, 2 of whom met criteria for NPSLE (2 patients had other manifestations of SLE), yielding an NPSLE prevalence of 1.5% (2 of 135) among patients who were positive for ANAs, and 0.2% (2 of 911) among all patients who underwent testing for ANAs.Conclusion. The prevalence of NPSLE in patients with psychosis who were positive for ANAs was low, at 1.5%. The low rate of clinically significant positive results would argue against routine testing for ANAs in patients with psychosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of Neuropsychiatric Lupus in Psychosis Patients Who Have Tested Positive for Antinuclear Antibodies

Spies

Gutjahr-Holland

Bertouch

et al. 2022

Arthritis Care & Research

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“…The role of ANAs for the diagnosis of NPSLE was evaluated by several studies. Unfortunately, the detection of ANAs among patients during their first psychiatric episode was revealed to be unspecific for the diagnosis of this disease, mostly because of the false positive results among patients under certain pharmacological treatment [92,93]. Extractable nuclear antigen (ENA) antibodies are a subgroup of ANAs so called because they are acid non-histone macromolecules obtained from the saline soluble fraction of cell nuclei.…”

Section: Systemic and Brain-targeting Autoantibodies In Sle And Npslementioning

confidence: 99%

Autoantibodies in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): Can They Be Used as Biomarkers for the Differential Diagnosis of This Disease?

Manca

2021

Clinic Rev Allerg Immunol

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Systemic lupus erythematosus is a complex immunological disease where both environmental factors and genetic predisposition lead to the dysregulation of important immune mechanisms. Eventually, the combination of these factors leads to the production of self-reactive antibodies that can target any organ or tissue of the human body. Autoantibodies can form immune complexes responsible for both the organ damage and the most severe complications. Involvement of the central nervous system defines a subcategory of the disease, generally known with the denomination of neuropsychiatric systemic lupus erythematosus. Neuropsychiatric symptoms can range from relatively mild manifestations, such as headache, to more severe complications, such as psychosis. The evaluation of the presence of the autoantibodies in the serum of these patients is the most helpful diagnostic tool for the assessment of the disease. The scientific progresses achieved in the last decades helped researchers and physicians to discover some of autoepitopes targeted by the autoantibodies, although the majority of them have not been identified yet. Additionally, the central nervous system is full of epitopes that cannot be found elsewhere in the human body, for this reason, autoantibodies that selectively target these epitopes might be used for the differential diagnosis between patients with and without the neuropsychiatric symptoms. In this review, the most relevant data is reported with regard to mechanisms implicated in the production of autoantibodies and the most important autoantibodies found among patients with systemic lupus erythematosus with and without the neuropsychiatric manifestations.

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“…All the patients included in the study were followed in an early intervention programme for psychosis at the Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, Brazil, which is the regional reference for the specialized treatment of FEP and composed by inpatient and outpatient units. This service ap-plies a standardised protocol for differential diagnosis at the moment of admission 20 , including detailed medical and psychiatric history, physical examination, blood screening (full blood count, urea, creatine, glutamine-oxaloacetic transaminase (GOT), prothrombin time, thyroid-stimulating hormone (TSH), antinuclear antibody and syphilis serology) 21 , besides urine tests to detect cannabis and cocaine metabolites, and neuroimaging exams (computed tomography and/ or magnetic resonance imaging). In face of any detected abnormalities in the initial screening, further exams were performed, according to the diagnostic hypothesis.…”

Section: Participantsmentioning

confidence: 99%

Plasma prevalence of anti-N-methyl-d-aspartate receptor IgG antibodies in early stages of psychosis

Loureiro

Corsi-Zuelli²,

Fachim³

et al. 2021

Ciênc. saúde coletiva

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We investigated the feasibility of including plasma anti-NMDAR antibody screening in the assessment of first-episode psychosis patients in an early intervention programme in the Southern hemisphere. Anti-NMDAR IgG antibodies were assessed by ELISA in 166 patients (64.0% men), 166 matched population-based controls and 76 patients’ siblings (30.3% men). Fisher’s exact test and ANOVA were performed. Positive anti-NMDAR antibody patients were more often observed in bipolar disorder (10.0%) than schizophrenia (2.4%) or psychotic depression (3.1%), although no significant differences were observed. Our results are not conclusive regarding the inclusion of plasma anti-NMDAR IgG antibodies in differential diagnostic protocols for psychosis.

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Antinuclear antibodies testing as a routine screening for systemic lupus erythematosus in patients presenting first‐episode psychosis

Abstract: Even though ANA detection is not specific, it is a low-cost procedure and could be an important screening test for NPSLE in the early-onset psychosis.

Cited by 12 publications

References 24 publications

Prevalence of Neuropsychiatric Lupus in Psychosis Patients Who Have Tested Positive for Antinuclear Antibodies

Prevalence of Neuropsychiatric Lupus in Psychosis Patients Who Have Tested Positive for Antinuclear Antibodies

Autoantibodies in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): Can They Be Used as Biomarkers for the Differential Diagnosis of This Disease?

Plasma prevalence of anti-N-methyl-d-aspartate receptor IgG antibodies in early stages of psychosis

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