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The heterogeneity of neuropsychiatric systemic lupus erythematosus is reflected in lack of association with cerebrospinal fluid cytokine profiles

Department of Rheumatology, Lund University Hospital, Lund, Sweden, andreas.jonsen{at}reum.lu.se

A A Bengtsson

Department of Rheumatology, Lund University Hospital, Lund, Sweden

O Nived

Department of Rheumatology, Lund University Hospital, Lund, Sweden

B Ryberg

Department of Neurology, Lund University Hospital, Lund, Sweden

L Truedsson

Department of Clinical Microbiology and Immunology, Lund University Hospital, Lund, Sweden

L Rönnblom

Section of Rheumatology, Department of Medical Sciences, Uppsala University, Sweden

G V Alm

Section of Immunology, Department of Veterinary Microbiology, Swedish University of Agricultural Sciences, Uppsala

G Sturfelt

Department of Rheumatology, Lund University Hospital, Lund, Sweden

The objectivewas to study the occurrenceof autoantibodiesand cytokinesin serum and cerebrospinal fluid (CSF) in neuropsychiatric systemic lupus erythematosus (NPSLE). In total, 28 consecutive patients with NPSLE and 16 systemic lupus erythematosus (SLE) patients without neuropsychiatric involvement (non-NPSLE) were studied. IFN-a, IL-6, IL-10, soluble terminal complement complex (TCC), anti-ribosomal P protein antibodies (anti-P) and anti-cardiolipin antibodies (aCL) were measured in serum and CSF by immunoassays. Analyses of white blood cell differential count, CSF-albumin/serum-albumin ratio, IgG-index in CSF and isoelectric focusing in serum and CSF were also performed. CSF specimens from 23 healthy individuals were used as controls. IFN-a was elevated in the CSF of 5 of 28 NPSLE patients compared to three of 14 among the non-NPSLE patients. IL-6 was elevated in CSF in three of 26 NPSLE patients. Normal concentration of IL-10 was found in CSF in all 27 NPSLE-patients analysed. IFN-a in serum was elevated in 18 of 28 NPSLE patients. No distinct clinical phenotype was related to elevated cytokine concentration in serum or CSF. One patient with cerebral involvement complicated by progressive multifocal leukoencephalopathy displayed a very high IFN-a concentration in serum. High concentration of TCC was present in CSF from only one patient with systemic vasculitis and focal cerebral symptoms. In conclusion, the results of this study suggest that the diagnostic value of serum and CSF concentrationsof IFN-a, IL-10, IL-6 and TCC is limited in unselected neuropsychiatricSLE, probably due to the heterogeneityof NPSLE pathogenesis.

Key Words: cerebrospinal fluid • cytokines • interferon-alpha • neuropsychiatric • systemic lupus erythematosus

Lupus, Vol. 12, No. 11, 846-850 (2003)
DOI: 10.1191/0961203303lu472sr


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