AB1030 NEUROPSYCHIATRIC MANIFESTATIONS IN CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS: RETROSPECTIVE STUDY IN ONE SINGLE CENTER
Authors: Maria Kaleda, Irina Nikishina, Svetlana Glukhova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Systemic lupus erythematosus is a complex autoimmune disorder characterized by multisystem involvement, including the nervous system, which elevate damage and mortality. The investigation of neuropsychiatric involvement in childhood-onset SLE (cSLE) is important in real clinical practice to improve the prognosis. <h3>Objectives</h3> The aim of this study was to assess neuropsychiatric manifestations (NM) in cSLE in one single center. <h3>Methods</h3> The study included all pts with cSLE who undergoing in-patient treatment in our center from 1992 to 2017 yy. Diagnosis of SLE was reviewed based on 2012 SLICC criteria. Data including sex, age at the time of onset, age at the time of diagnosis, physical examination, laboratory review, and neuropsychiatric inventory were extracted from our database. Classification of NM of cSLE was according to the 1999 American College of Rheumatology (ACR) neuropsychiatric manifestations of SLE case definitions. <h3>Results</h3> We included 218 consecutive pts with cSLE, of which 45 pts (20.6%) had neuropsychiatric involvement at the time of diagnosis (Tab.1). Neurolupus was significantly more frequently detected during the acute development of SLE (46.7% of patients, p = 0.003). Among immunological disorders, patients with NM often had antibodies to RNP (p = 0.073) in the absence of any differences in other immunological parameters. Of the clinical manifestations in patients with NM, chronic skin lesions were recorded more often (p = 0.076), while arthritis was detected relatively less frequently (p = 0.028). Serositis and nephritis were diagnosed significantly more often in the group of patients with NM (p = 0.003, 0.003, respectively). Of the hematological disorders, NM was relatively more frequently accompanied by leuco/lymphopenia (p = 0.087) and thrombocytopenia (p = 0.077). In general, the group of patients with NM was characterized by a higher degree of multiorgan involvment (the number of clinical manifestations was on average 5.6 and 3.7, respectively, p &lt;0.0001), but both groups were comparable for number of immunological disorders (p = 0.49). As early signs of NM, all patients had mood disorders and impaired school adaptation. In the structure of NM, central nervous system involvement prevailed (89%). 15 pts (33.3%) had experienced more than one NM. Headaches, cognitive dysfunction and cerebrovascular disease were the most common (28.9%, 28.9% and 24.4%, respectively). Other NM included distal polyneuropathy - 20%, episyndrom – 15.5%, acute confusional state – 11.1%, anxiety disorder – 11.1%, psychosis – 8.9%, paresis – 6.7%, chorea – 4.4%. <h3>Conclusion</h3> Acute onset, multiorgan lesions, mood disorders, impairment of school adaptation in a patient with suspected SLE should prompt investigations into diagnosis of the primary nervous system involvement. Patients with neuropsychiatric disorders require earlier complex aggressive therapy due to greater disease activity and poor prognosis. <h3>Disclosure of Interests</h3> None declared