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Central nervous system involvement in systemic lupus erythematosus: cerebral imaging and serological profile in patients with and without overt neuropsychiatric manifestations
G Sanna
Department of Medical Sciences, University of Cagliari, Cagliari, Italy
M Piga
Center of Nuclear Medicine, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
J W Terryberry
Specialty Laboratories, Santa Monica, CA, USA
M T Peltz
Center of Radiology, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
S Giagheddu
Neuropediatrics, Department of Neurosciences, University of Cagliari, Cagliari, Italy
L Satta
Center of Nuclear Medicine, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
A Ahmed
Specialty Laboratories, Santa Monica, CA, USA
A Cauli
Department of Medical Sciences, University of Cagliari, Cagliari, Italy
C Montaldo
Center of Radiology, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
G Passiu
Department of Medical Sciences, University of Cagliari, Cagliari, Italy
J B Peter
Specialty Laboratories, Santa Monica, CA, USA
Y Shoenfeld
Chaim Sheba Medical Center, Tel-Hashomer, Israel
A Mathieu
Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Cattedra di Reumatologia II, Centro per le Malattie Reumatiche Sistemiche, Dipartimento di Scienze Mediche, via San Giorgio 12, I-09100 Cagliari, Italy mathieu{at}pacs.unica.it
The aim of this study was to evaluate morphological and functional abnormalities by cerebral imaging in a series of systemic lupus erythematosus (SLE) patients with and without overt central nervous system (CNS) manifestations, and to detect possible relationships with clinical parameters and a large panel of autoantibodies, including those reactive against neurotypic and gliotypic antigens. 68 patients with SLE were investigated in a cross-sectional study which included clinical evaluation of symptoms, cerebral magnetic resonance imaging (MRI) and brain single photon emission tomography (SPECT) analysis, electroencephalography (EEG), and serological tests for antibodies directed against nuclear, cytoplasmic neuronal and glial cell-related antigens.
The results of this study showed: (1) a significant positive association of (a) anti-glial fibrillary acidic protein (GFAP) serum antibodies with neuropsychiatric (NP) manifestations and (b) antiserin proteinase 3 (anti-PR3/c-ANCA) serum antibodies with pathological cerebral SPECT; (2) the presence of significantly higher values of (a) SLICC organ damage index in patients with abnormal MRI and (b) SLAM activity index in patients with abnormal SPECT; and (3) the association of (a) abnormal MRI with nonactive NP manifestations and (b) combined abnormality of brain SPECT and MRI with the occurrence of overall overt NP manifestations and with those of the organic/major type.
Neuropsychiatric manifestations, namely those of the organic/major type, appeared to be significantly associated to the presence of a serum antibody against GFAP, a gliotypic antigen. There was also evidence of an association between SPECT abnormality and the presence of anti-PR3 (c-ANCA). Furthermore, brain imaging by MRI and SPECT applied to SLE patients appears to express CNS involvement significantly related to specific categories of NP manifestations. The abnormalities detected by the two tests seem to be preferentially associated with different activity phases of the NP disorder or of the lupus disease.
Key Words: systemic lupus erythematosus • central nervous system • autoantibodies • MRI • SPECT
Lupus, Vol. 9, No. 8,
573-583 (2000)
DOI: 10.1191/096120300678828695
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