SAT0227 CLINICAL AND IMMUNOLOGICAL PROFILE OF NEUROPSYCHIATRIC LUPUS IN SOUTH INDIA
Authors: B. Pinto, S. Cs, D. Susanne, R. Aithala, C. Kodishala, B. S. Charles, S. Kn, R. Nadig, G. R. Sarma, V. Shobha
Journal: Annals of the Rheumatic Diseases (2020)

Background: Neuropsychiatric manifestations are one of the least understood aspects of SLE. Objectives: To study the prevalence of NPSLE manifestations in our cohort and compare clinical and immunological features of patients with controls. Methods: This was a retrospective study in a tertiary care centre. Classification of SLE was as per SLICC criteria. All patients of SLE diagnosed in the last 5 years with NP manifestations as per the ACR definitions were included. Consecutive patients of SLE over last 2 years without NP manifestations were taken as controls. Results: Six hundred and thirty one patients with SLE were seen in our centre from Jan 2013 to Jun-2019. NPSLE manifestations as per the ACR definitions were seen in 100 patients (95 females) .137 (130 females) consecutive SLE patients without NP manifestations were included as controls. The commonest NPSLE manifestation was seizures followed by cerebrovascular accident (Table 1). NPSLE manifestation occurred at the first presentation in 77 patients. Forty patients had more than one NPSLE manifestation. Antiphosholipid (APl) antibodies (lupus anticoagulant and anticardiolipin antibody) were tested in 94 patients and positive in 25 (26.3%). Only 10 of the 23 patients with CVA were positive for APl. NPSLE syndromes were similar in APl positive and negative patients. As compared to controls, NPSLE patients had lower prevalence of mucocutaneous and musculoskeletal manifestations. There were no differences in the autoantibody profile in NPSLE patients versus controls. MRI of the brain was available in 65 NP episodes and 51 were abnormal. Ischaemic changes (22) were the commonest followed by T2/FLAIR hyperintensities (16). Cyclophosphamide was used for induction in 46 and Mycophenolate in 19 patients. Follow up of ≥ 6 months duration was available 93 patients. Over a mean follow up duration of 31.1 ± 22.7 months, 6 patiens had a NPSLE relapse and 10 died. Table 1. Prevalence of NP SLE manifestations (N=631) and clinical and immunological features NPSLE manifestations Prevalence (% ) Clinical Feature NPSLE (n=100 ) Controls (n=137 ) P value All 100(15.85% ) Age 29.1±11.6 28.18±9.79 NS Central Nervous System 65(10.3%) M:F 5:95 7:130 NS Aseptic meningitis 2(0.3%) Mucocutaneous 55(55%) 105(76.6%) &lt;0.001 Acute Confusional State 12(1.9%) Musculoskeletal 57(57%) 96(70%) 0.03 Cerebrovascular Disease 23(3.6%) Hemolytic Anaemia 19(19%) 40(29.2%) NS Cognitive Dysfunction 2(0.3%) Leucopenia 25(25%) 40(29.2%) NS Demyelinating Syndrome 3(0.5%) Thrombocytopenia 22(22%) 36(26.3%) NS Headache 12(1.9%) Serositis 10(10%) 16(11.7%) NS Movement Disorder 7(1.1%) Lupus Nephritis 41(41%) 38(27.7%) NS Myelopathy 5(0.8%) Direct Coomb’s Test 44(44%) 55(45.5%) NS Seizures 35(5.5%) Lupus anticoagulant 15(15%) 21(18.6%) NS Anticardiolipin 12(12%) 14(12.5%) NS Peripheral Nervous system 28(4.4%) Low complements 78(78%) 98(78.4%) NS AIDP 3(0.5%) dsDNA 44(44%) 67(52.8%) NS Autonomic Disorders 1(0.1%) Smith 38(38%) 51(40.8%) NS Cranial Neuropathy 5(0.8%) Nucleosome 43 (43%) 52 (41.9%) NS Mono neuropathy 9(1.4%) Histone 27 (27%) 40 (32.3%) NS Myasthenia Gravis 0 Ribo P 25(25%) 37(29.6%) NS Plexopathy 0 RNP/Sm 43(43%) 52(41.6%) NS Polyneuropathy 12(1.9%) scl70 4(4%) 5(4%) NS SSA 34(34%) 42(33.6%) NS Psychiatric 17(2.7%) SSB 10(10%) 18(14.5%) NS Mood Disorders 8(1.3%) Ro52 32(32%) 39(31.2%) NS Psychosis 13(2.1%) PmScl 0 5(4%) NS Anxiety Disorder 4(0.6%) PCNA 2(2%) 6(4.8%) NS Conclusion: Seizures and CVA are the commonest NPSLE syndromes. APl positivity was not associated with NPSLE in our cohort. Disclosure of Interests: None declared