AB1096 PREVALENCE, CHARACTERISTICS AND OUTCOMES OF NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS IN MOROCCO: A CASE SERIES OF 511 PATIENTS
Authors: H. Hanani, W. Ammouri, L. Kherroubi, S. Belkhettab, N. Mouatassim, H. Khibri, M. Maamar, H. Harmouche, Z. Tazi Mezalek, M. Adnaoui
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Neuropsychiatric manifestations in SLE vary susbtantially between patients. Despite diagnostic criteria and algorithms, their attribution to SLE represents a clinical challenge and requires to exclude any other potential cause. Some risk factors are correlated to neuropsychiatric involvement and mortality or other major adverse event. <h3>Objectives:</h3> To study the prevalence, characteristics and outcomes as well as prognostic factors for NPSLE onset and adverse outcomes <h3>Methods:</h3> Monocentric observational and analytical study carried out in Ibn Sina University Hospital Center; data of 511 patients with SLE, with and without neuropsychiatric manifestations according to ACR criteria, were collected retrospectively from January 2010 to June 2023. Statistical analysis was performed using Jamovi software. <h3>Results:</h3> Within this cohort, 121 patients featured neuropsychiatric manifestations (23.7%), including 94.2% of women with a median age at diagnosis of 28.5 years (IQI 21.8 - 37.3), a median number of 25 ACR/EULAR classification criteria and a median SLEDAI of 10. In 34.1% of cases neuropsychiatric revealed the disease. Most common manifestations were central in 88.3% of cases featuring headaches (33%), convulsions (32.4%), cerebrovascular disease (24.8%), demyelinating syndrome (7.9%) or myelopathy (6.1%); they were psychiatric in 32% of cases: mood disorders (45.5%), psychosis (28.1%) or cognitive dysfunction (25%); peripheral events were seen in 27.6% of cases: polyneuropathy (22.4%), or Guillain-Barré syndrome (6.5%). The mechanism was inflammatory in 70.6% of cases, and antiphospholipid syndrome was associated in 22.1% of patients. Four cases (3.3%) of posterior reversible encephalopathy syndrome were recorded. Most common featured clinical associations were: cutaneous (84%), articular (80%), renal (50%), hematological (67.6%) and cardiac or pulmonary (36%). All patients had an antinuclear antibody titer higher than 1/320, with a median lymphocyte level of 880 elements/mm3 and a median ESR of 40mm (first hour); complement was consumed in 57% of cases. Almost all patients received prednisone (95.7%), 82.5% were on synthetic antimalarials. Cyclophosphamide was used in 57.1% of cases followed by MMF in 26.2% and azathioprine in 29.1% of cases; 11.9% of patients were put on rituximab;22.9% benefited from intravenous immunoglobulins, and 1.6% from plasma exchanges. Thirty-three percents were on platelet antiaggregant or curative anticoagulation. Remission was achieved in 60.6%. An adverse outcome, defined as death, relapse, complication (infectious, thromboembolic or iatrogenic) or a stay in intensive care, occurred in 8.7%, 46.2%, 53.3% and 11.3% of cases respectively; 39.4% of relapses were neuropsychatric. The median follow-up duration was 98 months. NPSLE onset among SLE patients was positively correlated with female sex (OR at 6.2, p &lt; 0.001), joint involvement (OR at 4.2, p &lt; 0.001) and cardiac involvement (OR at 1.8, p &lt; 0.03). The occurrence of an adverse outcome among NPSLE patients was positively correlated with prednisone (OR 11, p&lt;0.03) and MMF (OR 5, p&lt;0.04), a correlation not found among patients who had received azathioprine or cyclophosphamide. <h3>Conclusion:</h3> The heterogeneity of NPSLE and its therapeutic implications requires to exclude all differential diagnoses and a systematic APS assessment. High rates of relapses and infectious complications call for regular monitoring and corticosteroid sparing. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>