Characteristic features of lupus patients with neuropsychiatric manifestations: a study from a single tertiary care center in Saudi Arabia

Abstract

Objective: This was a study reporting Neuropsychiatric Systemic Lupus Erythematosus Events (NPSLE) in Saudi lupus patients.
Methods: A retrospective study for adult patients who attended rheumatology clinics at King Fahad Medical City between 2014 and 2020 and fulfilled the Systemic Lupus International Collaborating Clinics classification criteria (SLICC). NPSLE identified based on ACR 1999 nomenclature. The primary outcome is to identify the most common NPSLE while the secondary outcome is to find the association between NPSLE and other major organs and with the radiological features.
Results: One hundred and forty eight Systemic Lupus Erythematosus (SLE) patients participated in the study, One hundred and thirteen (76.4%) females and 35 (23.6%) males. Twenty one (14.2%) of our patients had NPSLE of whom 16 (76.2%) were female patients. The most frequently recorded event is seizure (42.9%) followed by stroke (23.8%). Psychosis was the most dominant psychiatric symptom (9.5%). Depression, headache, acute confusion, transverse myelitis, and peripheral neuropathy each presented by 4.8%. Lupus nephritis was diagnosed in 66.7% of patients with NPSLE while carditis was 28%. No significant association was found between aPL and anti-ds- DNA positivity and NPSLE. The most obvious abnormalities in imaging (MRI/ MRA/ MRV) were abnormal high signal intensity that was identified in 8 (57.1%) patients, infarction in 4 (28.6%) patients while vasculitic changes was in 3 (21.4%) patients.
Conclusions: NPSLE are reported prominently among female patients with seizure being the most common symptom followed by cerebrovascular accidents (CVA). The kidney is the most obvious major organ involved in patients with NPSLE followed by the heart. Abnormal signal intensity, infarction and vasculitis are the most noticeable lesions in imaging respectively.