Abstract
Objective
We wished to determine the prevalence of cerebral atrophy and focal lesions in a cohort of patients with newly diagnosed systemic lupus erythematosus (SLE) and the association of these brain abnormalities with clinical characteristics.
Methods
A total of 97 patients with SLE, within 9 months of diagnosis, with 4 or more American College of Rheumatology classification criteria, were enrolled. Brain magnetic resonance imaging was performed.
Results
The patients were 97% female, mean age 38.1 (SD 12.2) years, education 15.1 (2.8) years; 59 Caucasian, 11 African American, 19 Hispanic, 5 Asian, and 3 other ethnicity. Cerebral atrophy was prevalent in 18% (95% CI 11%–27%): mild in 12%, moderate in 5%. Focal lesions were prevalent in 8% (95% CI 4%–16%): mild in 2%, moderate in 5%, severe in 1%. Patients with cerebral atrophy were more likely to have anxiety disorder (p = 0.04). Patients with focal lesions were more likely to be African American (p = 0.045) and had higher Safety of Estrogens in Lupus Erythematosus National Assessment SLEDAI scores (p = 0.02) and anti-dsDNA (p = 0.05).
Conclusion
In this population with newly diagnosed SLE, brain abnormalities were prevalent in 25% of patients. These findings suggest that the brain may be affected extremely early in the course of SLE, even before the clinical diagnosis of SLE is made. Followup of these patients is planned, to determine the reversibility or progression of these abnormalities and their association with and potential predictive value for subsequent neuropsychiatric SLE manifestations.
Key Indexing Terms:Footnotes
-
M. Petri, MD, MPH, Professor; M. Naqibuddin, MBBS, MPH, Johns Hopkins University; K.A. Carson, ScM, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; D.J. Wallace, MD; M.H. Weisman, MD, Cedars-Sinai Medical Center/David Geffen School of Medicine at UCLA; S.L. Holliday, PhD, ABPP, Chief, Psychology Service, South Texas Veterans Health Care System, San Antonio, TX; M. Sampedro, Johns Hopkins University; S. Narayana, PhD, Research Imaging Center and Department of Radiology, UT Health Science Center, San Antonio, TX; P.T. Fox, MD, Research Imaging Center, UT Health Science Center, South Texas Veterans Health Care System; C. Franklin, BS, Research Imaging Center, UT Health Science Center; P. Padilla, BS; R.L. Brey, MD, Department of Neurology, UT Health Science Center.
-
The Brain CONECTIONS study is supported by NIH RO1-AR049125, AR043727, and the Johns Hopkins University General Clinical Research Center (K. Carson is supported by M01-RR00052) and the University of Texas Health Science Center at San Antonio Frederic C. Bartter General Clinical Research Center (MO1-RR01346).
- Accepted for publication July 4, 2008.