Clinical features of transverse myelitis associated with systemic lupus erythematosus

Abstract

Objective This study aimed to identify the clinical characteristics and prognostic factors of systemic lupus erythematosus with transverse myelitis (SLE-TM) in a relatively large patient series. Methods This retrospective study considered 45 SLE-TM individuals treated as inpatients and outpatients at Peking Union Medical College Hospital between 1993 and 2018. SLE-TM patients were compared with 180 controls, and SLE-TM patients with neuromyelitis optica spectrum disorder (NMOSD) were compared to those without NMOSD. Results Compared to controls, the SLE-TM group frequently had a fever and had a significantly higher positive rate of anticardiolipin and lupus anticoagulant. Among the 45 patients, 22 met the NMOSD criteria. Compared to non-NMOSD patients, NMOSD patients had a lower incidence of rash ( p = 0.023), serositis ( p = 0.042) and renal disorder ( p = 0.073); a lower prevalence of decreased complement ( p = 0.083); and lower rates of positive anti-dsDNA ( p = 0.074) and anti-Sm ( p = 0.042). Among 22 SLE-TM patients with NMOSD, 18 underwent aquaporin 4 antibody testing, with 11 showing positive results. Out of the 45 patients, 39 were given methylprednisolone pulse treatment. After treatment, 32 patients had lower-limb muscle strength recovery (recovered group), whereas 13 had no change and persistent severe neurological deficits (non-recovered group). Compared to the recovered group, the non-recovered group were younger ( p = 0.002), had a higher likelihood of having a fever ( p = 0.020), initial severe myelitis ( p < 0.001), long spinal segment involvement ( p = 0.017) and higher C-reactive protein levels ( p = 0.020). Methylprednisolone pulse given within two weeks of onset was more frequent in the recovered group than in the non-recovered group ( p = 0.082). Conclusions Disease characteristics differed between SLE-TM patients with and without NMOSD. SLE and NMOSD tended to be co-morbidities. Initial severe neurological impairment, extensive spinal cord lesions, hyper-inflammation and delayed steroid impulse treatment could be predictors of poor outcome for SLE-TM.

Comparative analysis of clinical and imaging data of first-attack neuromyelitis optica spectrum disorders with and without connective tissue disease

“…This phenomenon was also observed in this study (not specified). In many previously published articles, rheumatologists have recommended that serum AQP4 and myelin oligodendrocyte glycoprotein antibodies should be considered for all patients with CTD with myelitis, bilateral optic neuritis, and large fusion brain damage (30)(31)(32)(33)(34). Similarly, neurologists should consider testing for these autoantibodies in patients with NMOSD.…”

Suspected Transverse Myelitis with Normal MRI and CSF Findings in a Patient with Lupus: What to Do? A Case Series and Systematic Review

“…23 Another patient was treated with MP IV followed by cyclophosphamide and recovered completely after 5 days. 24 The last patient was treated with MP and cyclophosphamide IV and showed no clinical improvement after 10 years of follow-up. Notes: a Transverse myelitis criteria: A: clinical characteristics; B: clinical characteristics + confirmation based on additional investigations; C: 2002 TM working group criteria; 3 D: ACR case definitions; 2 b Two patients eventually excluded from this study but data personally provided by authors; c % Female; d CSF: + = abnormal; -= normal; NA = not available; e Outcome: ++ = full recovery; + = nearly complete recovery; ± = partial improvement; -= no improvement; -= death; f In this article, outcome +/++ was defined as walking without assistance and ±: walking with assistance or urinary incontinence remaining.…”

“…Information of two of the three MRI-/CSF-patients was not available in the article and later provided by the authors. 23,24 Of the three patients, one patient was treated with MP IV for 3 days and cyclophosphamide IV 1x followed by treatment with azathioprine and showed partial improvement at 15 months. 23 Another patient was treated with MP IV followed by cyclophosphamide and recovered completely after 5 days.…”

Extensive Longitudinal Transverse Myelitis after Influenza A Virus Infection in a Patient with Systemic Lupus Erythematosus

“…In patients with SLE, cases of TM are usually seen during the early stages of lupus when patients exhibit higher levels of disease activity [27]. In our case, TM occurred nine years after the diagnosis of SLE.…”