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A critical analysis of the tools to evaluate neuropsychiatric lupus

Clark, KEN; Clark, CN; Rahman, A; (2017) A critical analysis of the tools to evaluate neuropsychiatric lupus. Lupus , 26 (5) pp. 504-509. 10.1177/0961203317690242. Green open access

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Abstract

Neuropsychiatric symptoms occur commonly in patients with systemic lupus erythematosus, but they are not always due to active disease. It is crucial to identify cases that are due to active systemic lupus erythematosus so that appropriate treatment can be instituted. There is no single serological or imaging test that distinguishes active neuropsychiatric systemic lupus erythematosus from neuropsychiatric manifestations caused by other factors such as infection. Most patients with neuropsychiatric systemic lupus erythematosus have generalised features of disease activity. Raised anti-dsDNA and low C3 complement levels are often seen, but are not an invariable guide. The presence of antiphospholipid antibodies is more suggestive of thrombotic than inflammatory causation. A number of other autoantibody tests have been proposed as biomarkers for neuropsychiatric systemic lupus erythematosus, but results in clinical studies have been inconsistent and none has so far entered routine clinical practice. Cerebrospinal fluid features and magnetic resonance imaging appearances are non-specific in neuropsychiatric systemic lupus erythematosus, but are useful in excluding other causes of neuropsychiatric symptoms. Newer magnetic resonance imaging sequences show promise for distinguishing new neuropsychiatric systemic lupus erythematosus activity from previous damage and recent research suggests these may correlate with changes in cognitive function in patients with systemic lupus erythematosus. However, formal cognitive testing is seldom carried out in the acute setting.

Type: Article
Title: A critical analysis of the tools to evaluate neuropsychiatric lupus
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/0961203317690242
Publisher version: http://dx.doi.org/10.1177/0961203317690242
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Rheumatology, Systemic lupus erythematosus, neuropsychiatric, autoantibodies, magnetic resonance imaging, CEREBROSPINAL-FLUID AUTOANTIBODIES, P-PROTEIN ANTIBODIES, COGNITIVE DYSFUNCTION, ANTIPHOSPHOLIPID SYNDROME, CELL ANTIBODIES, ERYTHEMATOSUS, DIAGNOSIS, COHORT, SLE, PATHOGENESIS
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation
URI: https://discovery.ucl.ac.uk/id/eprint/1552760
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