Relationship Between Clinical and Immunological Features with Magnetic Resonance Imaging Abnormalities in Female Patients with Neuropsychiatric Systemic Lupus Erythematosus

Predictive factors for the development of lupus nephritis after diagnosis of systemic lupus erythematosus

OBJECTIVES

To determine predictive factors for the development of lupus nephritis (LN) at the time of diagnosis of systemic lupus erythematosus (SLE).

METHODS

A case-control study was carried out in a single center, 595 patients with a diagnosis of SLE without LN participated by clinical or laboratory parameters at diagnosis, they were followed for a mean of 6.8 (+4.5) years, conforming to the data of their files two groups: with NL (cases) and without NL (controls) at the end of the follow-up. Sociodemographic, clinical, serological, immunological variables and the albumin - globulin ratio (AGR), calculated as albumin/total protein-albumin at diagnosis, were compared between both groups. A univariate and multivariate analysis was carried out.

RESULTS

124 (20.8%) patients had LN during follow-up and 471 (79.2%) did not develop LN. Univariate analysis: variables significantly associated with the development of LN: smoking, oral ulcers, serositis, more than four classification criteria, abrupt onset of SLE, higher SLEDAI value, low AGR, low C3 levels, high anti-titers. -Double stranded DNA (anti-dc DNA), anti-nucleosomes and positivity of immunofluorescence in skin. Multivariate analysis: predictors of developing LN: elevated serum levels of anti-dc DNA (odds ratio (OR): 15.82; confidence interval (CI): 1.08-1.22, P < .0001), decrease in the C3 fraction (OR: 36.50; CI: 13.52-81.91, P < .0001) and the RAG < 1 (OR: 47.58; CI: 11.85-79.17, P < .0001).

CONCLUSION

The AGR below one was the greatest predictor of the appearance of LN, together with the low levels of C3 and high levels of anti-dc DNA antibodies, they may contribute to identifying patients with a higher risk of presenting LN.

Association Between Hypocomplementemia (C3 and C4) and MRI Findings in Different Neuropsychiatric Lupus Syndromes in a Tertiary Hospital

Objective The aim of this study was to describe the magnetic resonance imaging (MRI) findings and correlate them with the complements level. Methodology This is a retrospective chart review study involving 187 lupus patients attending the rheumatology clinic during the period between 2010 and 2020. Out of the 187 patients, only 49 patients were diagnosed to have neuropsychiatric lupus manifestation and underwent MRI study. Results We included 49 neuropsychiatric systemic lupus erythematosus patients with a mean age of 35.33 years; most of them were Saudi (51%), with disease duration between -six and nine years (40.8%). In regard to MRI brain findings, 51% had abnormal findings, most commonly white matter changes in 42.9% followed by contrast enhancement in 36.7% and mild volume loss in 16.3%. Regarding the complement level, 21 (42.9%) patients had a low C3 level and 35 (71.4%) had a low C4 level. Lastly, following the main objective, C3 and C4 do not have a statistically significant relationship with white matter lesion given the sample of this data (p = 0.589 and p = 0.657, respectively). Conclusion MRI provides a significant clinical information to evaluate neuropsychiatric lupus manifestations. These clinical data can be correlated with immunological findings, which can help in the early diagnosis and management of this disease.

Towards an understanding of women's brain aging: the immunology of pregnancy and menopause

Women are at significantly greater risk of developing Alzheimer's disease and show higher prevalence of autoimmune conditions relative to men. Women's brain health is historically understudied, and little is therefore known about the mechanisms underlying epidemiological sex differences in neurodegenerative diseases, and how female-specific factors may influence women's brain health across the lifespan. In this review, we summarize recent studies on the immunology of pregnancy and menopause, emphasizing that these major immunoendocrine transition phases may play a critical part in women's brain aging trajectories.

A Predictive Model for Estimation Risk of Proliferative Lupus Nephritis

BACKGROUND

Lupus nephritis (LN) is classified by renal biopsy into proliferative and nonproliferative forms, with distinct prognoses, but renal biopsy is not available for every LN patient. The present study aimed to establish an alternate tool by building a predictive model to evaluate the probability of proliferative LN.

METHODS

In this retrospective cohort with biopsy-proven LN, 382 patients in development cohort, 193 in internal validation cohort, and 164 newly diagnosed patients in external validation cohort were selected. Logistic regression model was established, and the concordance statistics (C-statistics), Akaike information criterion (AIC), integrated discrimination improvement, Hosmer-Lemeshow test, and net reclassification improvement were calculated to evaluate the performance and validation of models.

RESULTS

The prevalence of proliferative LN was 77.7% in the whole cohort. A model, including age, gender, systolic blood pressure, hemoglobin, proteinuria, hematuria, and serum C3, performed well on good-of-fit and discrimination in the development chohort to predict the risk of proliferative LN (291 for AIC and 0.84 for C-statistics). In the internal and external validation cohorts, this model showed good capability for discrimination and calibration (0.84 and 0.82 for C-statistics, and 0.99 and 0.75 for P values, respectively).

CONCLUSION

This study developed and validated a model including demographic and clinical indices to evaluate the probability of presenting proliferative LN to guide therapeutic decisions and outcomes.

The diagnosis and clinical management of the neuropsychiatric manifestations of lupus

Neuropsychiatric (NP) involvement in Systemic Lupus Erythematosus (SLE), can be a severe and troubling manifestation of the disease that heavily impacts patient's health, quality of life and disease outcome. It is one of the most complex expressions of SLE which can affect central, peripheral and autonomous nervous system. Complex interrelated pathogenetic mechanisms, including genetic factors, vasculopathy, vascular occlusion, neuroendocrine-immune imbalance, tissue and neuronal damage mediated by autoantibodies, inflammatory mediators, blood brain barrier dysfunction and direct neuronal cell death can be all involved. About NPSLE a number of issues are still matter of debate: from classification and burden of NPSLE to attribution and diagnosis. The role of neuroimaging and new methods of investigation still remain pivotal and rapidly evolving as well as is the increasing knowledge in the pathogenesis. Overall, two main pathogenetic pathways have been recognized yielding different clinical phenotypes: a predominant ischemic-vascular one involving large and small blood vessels, mediated by aPL, immune complexes and leuko-agglutination which it is manifested with more frequent focal NP clinical pictures and a predominantly inflammatory-neurotoxic one mediated by complement activation, increased permeability of the BBB, intrathecal migration of autoantibodies, local production of immune complexes and pro-inflammatory cytokines and other inflammatory mediators usually appearing as diffuse NP manifestations. In the attempt to depict a journey throughout NPSLE from diagnosis to a reasoned therapeutic approach, classification, epidemiology, attribution, risk factors, diagnostic challenges, neuroimaging techniques and pathogenesis will be considered in this narrative review based on the most relevant and recent published data.