Prevalence and characteristics of neuropsychiatric involvement in an Egyptian cohort of systemic lupus erythematosus patients: a single-center retrospective cohort

Abstract

Background The aim of this study was to retrospectively investigate the prevalence and characteristics of neuropsychiatric (NP) involvement in a cohort of systemic lupus erythematosus (SLE) patients from a single tertiary center. Results Of 301 included patients’ medical records, the prevalence of NPSLE, that was defined according to the American College of Rheumatology Nomenclature of 1999, was 33.5% (101/301), of whom 10 (9.9%) were males. The mean age at the last visit of patients with NP involvement was 29.1 ± 8.2 years, whereas the mean age at onset was 21.9 ± 7.3 years, and the mean disease duration was 89.8 ± 59.4 months. The most common NP manifestations were psychosis [34/101 (33.7%)], followed by seizures [22/101 (21.8%)]. Compared to those without NPSLE, patients with NP involvement were characterized by having a younger age of onset (p < 0.001) had a longer disease duration (p = 0.02). Of the cumulative characteristics recorded, NPSLE patients showed a higher prevalence of cutaneous vasculitis (p = 0.002), discoid rash (p = 0.03), pleurisy and pleural effusion (p = 0.004, p = 0.03, respectively), pericarditis (p = 0.007), thrombocytopenia (p = 0.04), and secondary antiphospholipid (APS) (p = 0.04); however, there was no difference in any of the included serologic features between the two groups. Patients with NPSLE had a higher median disease activity score [Systemic Lupus Erythematosus Disease Activity Index-2 K (SLEDAI-2 K)] at the disease onset (p = 0.008), yet it was comparable to those without NP involvement at the last visit (p = 0.3). NPSLE patients demonstrated a higher median damage score (p < 0.001) that was assessed according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score. NPSLE patients with secondary APS showed a higher prevalence of cerebrovascular accidents (CVA) (p < 0.001), while those without APS developed psychosis more frequently (p = 0.03). Conclusion Neuropsychiatric SLE patients (33.5%) demonstrated a younger age of onset, higher prevalence of secondary APS and distinct clinical characteristics, and had higher disease damage. APS-positive NPSLE patients had a higher prevalence of CVA, while APS-negative patients showed a higher prevalence of psychosis.

Neuropsychiatric lupus erythematosus in a cohort of Egyptian patients

“…While the NPSLE manifestations can affect the disease activity and damage scores, many other systemic affection have also comparable effect on them. This is in contrast to previous studies [38,58].…”

“…In the current work, a statistical significant difference of C3 (p = 0.025) and C4 (p = 0.008) levels, lupus anticoagulant level (p = 0.033) and antiphospholipid syndrome (p = 0.030), was found between the studied groups. This goes in accordance with Magro-Checa et al [55] and partially with Medhat et al [38] regarding antiphospholipid syndrome and other studies regarding complement levels [56,57].…”

“…Other recent studies report psychosis as a rare NSSLE event [36,37]. Similar to this finding, another Egyptian study in 2020 reported psychosis as the most prevalent NPSLE [38]. This high prevalence among our patients as patients of African descent were also more likely to develop psychosis than other race/ethnicity [39].…”

“…There is a limited evidence to support an association between demographic characteristics and NPSLE [54]. This is in contrast to a recent Egyptian study that found NPSLE patients were characterized by being younger with an earlier age of onset of lupus [38].…”

Cerebrovascular Accident as a First Manifestation of Neuropsychiatric Systemic Lupus Erythematosus; a Comprehensive Review; a Case Report

“…If a suspected NPSLE patient has one of the two items mentioned above, it is known as definite NPSLE (Figure 7) [14,15,19].…”