Risk factors for central nervous system involvement in systemic lupus erythematosus.

We investigated risk factors for central nervous system (CNS) involvement in systemic lupus erythematosus (SLE), in 32 such patients individually matched 1 : 3 to 96 control SLE patients without CNS events. Univariate analysis showed that CNS involvement was significantly associated with the antiphospholipid syndrome (APS) as well as its features: arterial thrombosis, recurrent fetal loss, livedo reticularis and IgG anticardiolipin (aCL) antibodies in high titres. Other potential associations included cutaneous vasculitic lesions, thrombocytopenia, positive ANA, anti-SS-B/La and low serum levels of C(3) and C(4) complement components, while articular manifestations and discoid rash were significantly less common in patients with neuropsychiatric (NP) disease. In multivariate modeling, CNS involvement was strongly associated with cutaneous vasculitic lesions OR 33, 95% CI 1.5-720) and arterial thromboses (OR 13, 95%CI 0.82-220), and negatively related to the presence of articular manifestations (OR 0.015, 95%CI 0.00-0.17) and discoid rash (OR 0.004, 95%CI 0.00-0.35). Associations with APS-related arterial thromboses and vasculitis point to the importance of arterial vascular pathophysiology in the pathogenesis of NP disease in SLE. Patients with articular manifestations and discoid rash are at very low risk of NP events. Patients with an adverse SLE disease profile may require closer observation and may be the target group for studying pre-emptive interventions.

[1]  J. Ioannidis,et al.  HLA associations of anti-beta2 glycoprotein I response in a Greek cohort with antiphospholipid syndrome and meta-analysis of four ethnic groups. , 1999, Human immunology.

[2]  W A Wilson,et al.  International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. , 1999, Arthritis and rheumatism.

[3]  Caroline Gordon,et al.  The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. , 1999, Arthritis and rheumatism.

[4]  J. Barker,et al.  Thrombogenic properties of murine anti-cardiolipin antibodies induced by beta 2 glycoprotein 1 and human immunoglobulin G antiphospholipid antibodies. , 1996, Circulation.

[5]  L. Sammaritano,et al.  Antiphospholipid Antibodies Activate Vascular Endothelial Cells , 1996, Lupus.

[6]  G. Hughes,et al.  Association of antiphospholipid antibodies with central nervous system disease in systemic lupus erythematosus. , 1995, The American journal of medicine.

[7]  S. West,et al.  Neuropsychiatric lupus erythematosus: a 10-year prospective study on the value of diagnostic tests. , 1995, The American journal of medicine.

[8]  S. Pierangeli,et al.  Comparison of the Effects of Anticardiolipin Antibodies from Patients with the Antiphospholipid Syndrome and with Syphilis on Platelet Activation and Aggregation , 1995, Thrombosis and Haemostasis.

[9]  G. Hughes,et al.  Association between antiphospholipid antibodies and epilepsy in patients with systemic lupus erythematosus. , 1994, Arthritis and rheumatism.

[10]  L. Sd,et al.  Cutaneous manifestations of lupus erythematosus. , 1994, Rheumatic diseases clinics of North America.

[11]  S. Laman,et al.  Cutaneous manifestations of lupus erythematosus. , 1994, Rheumatic diseases clinics of North America.

[12]  A. Drosos,et al.  Systemic Lupus Erythematosus in Greece. Clinical Features, Evolution and Outcome: a Descriptive Analysis of 292 Patients , 1993, Lupus.

[13]  J. Sixma,et al.  Antiphospholipid Antibody Positive Sera Enhance Endothelial Cell Procoagulant Activity – Studies in a Thrombosis Model , 1992, Thrombosis and Haemostasis.

[14]  M. Rosove,et al.  Antiphospholipid Thrombosis: Clinical Course after the First Thrombotic Event in 70 Patients , 1992, Annals of Internal Medicine.

[15]  N. Patronas,et al.  Pulse cyclophosphamide for severe neuropsychiatric lupus. , 1991, The Quarterly journal of medicine.

[16]  M. Greaves,et al.  Inhibition of activated protein C and its cofactor protein S by antiphospholipid antibodies , 1990, British journal of haematology.

[17]  J. Sánchez-Guerrero,et al.  Antiphospholipid Antibodies and the Antiphospholipid Syndrome in Systemic Lupus Erythematosus A Prospective Analysis of 500 Consecutive Patients , 1989, Medicine.

[18]  J. Sánchez-Guerrero,et al.  Hemocytopenia in systemic lupus erythematosus. Relationship to antiphospholipid antibodies. , 1989, The Journal of rheumatology.

[19]  G. Hughes,et al.  Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome. , 1989, The American journal of medicine.

[20]  J. Soria,et al.  Effect of Lupus Anticoagulant on Antithrombogenic Properties of Endothelial Cells - Inhibition of Thrombomodulin-Dependent Protein C Activation , 1988, Thrombosis and Haemostasis.

[21]  O. Devinsky,et al.  Clinical and neuropathological findings in systemic lupus erythematosus: The role of vasculitis, heart emboli, and thrombotic thrombocytopenic purpura , 1988, Annals of neurology.

[22]  A. Drosos,et al.  Anticardiolipin antibodies in unselected autoimmune rheumatic disease patients. , 1987, Clinical immunology and immunopathology.

[23]  A. Drosos,et al.  Enzyme immunoassays for the detection of IgG and IgM anti-dsDNA antibodies: clinical significance and specificity. , 1987, Clinical and Experimental Rheumatology.

[24]  S. Shapiro,et al.  The use of the dilute Russell viper venom time for the diagnosis of lupus anticoagulants. , 1986, Blood.

[25]  A. Hamsten,et al.  ANTIBODIES TO CARDIOLIPIN IN YOUNG SURVIVORS OF MYOCARDIAL INFARCTION: AN ASSOCIATION WITH RECURRENT CARDIOVASCULAR EVENTS , 1986, The Lancet.

[26]  L. Jovanovič,et al.  Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus. , 1985, The New England journal of medicine.

[27]  C. Mackworth-Young,et al.  ANTICARDIOLIPIN ANTIBODIES: DETECTION BY RADIOIMMUNOASSAY AND ASSOCIATION WITH THROMBOSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS , 1983, The Lancet.

[28]  J F Fries,et al.  The 1982 revised criteria for the classification of systemic lupus erythematosus. , 1982, Arthritis and rheumatism.

[29]  J. Fries,et al.  A multicenter study of outcome in systemic lupus erythematosus. I. Entry variables as predictors of prognosis. , 1982, Arthritis and rheumatism.

[30]  J. Fries,et al.  A multicenter study of outcome in systemic lupus erythematosus. II. Causes of death. , 1982, Arthritis and rheumatism.

[31]  C. H. McKenna.  Central nervous system systemic lupus erythematosus. , 1982, Minnesota medicine.

[32]  J. F. Wolfe,et al.  Identification of a clinical subset of systemic lupus erythematosus by antibodies to the SM antigen. , 1979, Arthritis and rheumatism.

[33]  M. Verity,et al.  Central nervous system involvement in systemic lupus erythematosus: a review of neuropathologic findings in 57 cases, 1955--1977. , 1979, Seminars in arthritis and rheumatism.

[34]  J. Winfield,et al.  Serologic studies in patients with systemic lupus erythematosus and central nervous system dysfunction. , 1978, Arthritis and rheumatism.

[35]  F. Arnett,et al.  NEUROPSYCHIATRIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS: DIAGNOSIS, CLINICAL SPECTRUM, AND RELATIONSHIP TO OTHER FEATURES OF THE DISEASE , 1976, Medicine.

[36]  P. Cheah,et al.  Mortality in Systemic Lupus Erythematosus: A 10-Year Review , 1973, British medical journal.

[37]  D. Estes,et al.  THE NATURAL HISTORY OF SYSTEMIC LUPUS ERYTHEMATOSUS BY PROSPECTIVE ANALYSIS , 1971, Medicine.

[38]  E. Richardson,et al.  The neurological manifestations of systemic lupus erythematosus. , 1968, Medicine.

[39]  I. Janota.  ADNEXAL SKIN TUMOURS IN NIGERIA , 1967, The British journal of dermatology.