الفهرس 
NEUROPSYCHIATRIC SYSTEMIC LUPUSOnly 14 pages are availabe for public view
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Abstract
During follow-up, 12 patients developed clinical evidence of NPSLE. Out of those patients, 2 had cognitive dysfunction, 2 had neuropsychiatric manifestations (focal convulsions, severe depression and moderate anxiety in one patient and TIATs, moderate depression and signs of pyramidal tract lesion in the other patient). The remaining 8 patients had both clinical evidence of cognitive dysfunction and neuropsychiatric manifestations (signs of pyramidal tract lesion in 2 patients, TIATs and moderate depression in another 2 patients, sensory changes suggestive of peripheral neuritis and severe depression in another patient, lower motor cranial nerve lesions localized to brain stem and severe depression in one patient, signs of pyramidal tract lesion with severe anxiety in another patient and focal convulsions, moderate depression and lower motor cranial nerve lesions localized to brain stem in the remaining patient).
Lupus patients had significantly higher serum anti-ganglioside M1 IgM antibodies than healthy controls (P < 0.001). In contrast, lupus patients and healthy controls had comparable values of serum anti-ganglioside M1 IgG antibodies (P = 0.4).
Seropositivity of anti-ganglioside M1 IgM antibodies was found in 33.3% (10/30) of lupus patients, while seropositivity of anti-ganglioside M1 IgG antibodies was found in 13.3% (4/30) of those patients. In addition, 33.3% (10/30) of lupus patients were seropositive for anti-ganglioside M1 IgM and/or IgG antibodies.
On the other hand, patients who developed clinical evidence of NPSLE during follow-up (n=12) had significantly higher serum anti-ganglioside M1 IgM antibodies than patients without such evidence (n=18), P < 0.001. In contrast, patients with and without NPSLE had comparable values of serum anti-ganglioside M1 IgG antibodies (P = 0.1).
Lupus patients had significantly higher serum anti-cardiolipin IgM antibodies than healthy controls (P < 0.001). In contrast, lupus patients and healthy controls had comparable values of serum anti-cardiolipin IgG antibodies (P = 0.5).
Seropositivity of anti-cardiolipin IgM antibodies was found in 16.7% (5/30) of lupus patients, while seropositivity of anti-cardiolipin IgG antibodies was found in 13.3% (4/30) of those patients. In addition, 16.7% (5/30) of lupus patients were seropositive for anti-cardiolipin IgM and/or IgG antibodies. On the other hand, patients with and without NPSLE had comparable values of serum anti-cardiolipin IgM and IgG antibodies (P = 0.4 and P = 0.1, respectively).
At the time of initial evaluation, before clinical presentation of NPSLE, seropositivity of anti-ganglioside M1 and anti-cardiolipin antibodies were found in 83.3% and 16.7%, respectively of patients who developed clinical evidence of NPSLE, later on, during follow-up. In contrast, none of the 18 patients who had no clinical evidence of NPSLE was seropositive for anti-ganglioside M1 antibodies. On the other hand, 16.7% of those patients were seropositive for anti-cardiolipin antibodies.
Clinical evidence of cognitive dysfunction was detected in 10 lupus patients (33.3%) during follow-up. Thus, 83.3% (10/12) of lupus patients with clinical evidence of NPSLE had cognitive dysfunction. Deficits in arithmetic, digit span, digit symbol and block design subsets of verbal and performance IQ were found in 6, 5, 4 and 3 children with cognitive dysfunction, respectively. On the other hand, clinical evidence of cognitive dysfunction was found in only 6.7% (2/30) of healthy children. One child had deficits in arithmetic and digit span and the other one had deficits in arithmetic and block design. The frequency of cognitive dysfunction was significantly higher in lupus patients than healthy children, P < 0.001.
Lupus children with cognitive dysfunction had significantly higher serum levels of anti-ganglioside M1 IgM than those with normal cognitive function. In addition, there was a significant positive association between anti-ganglioside M1 seropositivity and cognitive dysfunction as the frequency of anti-ganglioside M1 seropositivity was significantly higher in patients with cognitive dysfunction than patients with normal cognitive function (P < 0.001). Moreover, anti-ganglioside seropositivity had a significant risk for association with cognitive dysfunction (odds ratio: 36; 95% CI: 4.3-302.8).
On the other hand, there was non significant difference between serum levels and the frequency of anti-cardiolipin seropositivity of patients with and without cognitive dysfunction (P = 0.48).
There was non-significant statistical difference between SLEDAI of patients with and without clinical evidence of NPSLE (P = 0.2) and seropositivities of anti-ganglioside M1 and anti-cardiolipin (P = 0.7 and P = 0.6, respectively). In addition, serum anti-ganglioside M1 IgG and IgM and anti-cardiolipin IgG and IgM antibodies did not correlate significantly to SLEDAI of lupus patients (P = 0.7, P = 0.6, P = 0.2 and P = 0.4, respectively).
In addition, there was non-significant associations between seropositivities of both ANA and anti ds-DNA and clinical evidence of NPSLE (P = 0.3 and P = 0.4, respectively). Similarly, ANA and anti ds-DNA had no significant associations with seropositivities of anti-ganglioside M1 (P = 0.3 and P = 0.4, respectively) and anti-cardiolipin antibodies (P = 0.8 and P = 0.7, respectively).
Serum anti-ganglioside M1 IgG and IgM and anti-cardiolipin IgG and IgM antibodies did not correlate significantly to either the age of lupus patients (P = 0.8, P = 0.3, P = 0.1 and P = 0.6, respectively) or the duration of illness (P = 0.7, P = 0.7, P = 0.0.6 and P = 0.5, respectively).
In conclusion, serum anti-ganglioside M1 antibodies have a higher predictive value for NPSLE than other antibodies used in routine laboratory diagnosis of this disease. Thus, these antibodies may be reliable parameters for diagnosis and early prediction of NPSLE, before clinical manifestations ensue. In addition, anti-ganglioside M1 antibodies may play a role in cognitive dysfunction of lupus patients.