Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: A multicenter study.
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Kısaarslan Ayşenur Paç, Çiçek Sümeyra Özdemir, Batu Ezgi D, Şahin Sezgin, Gürgöze Metin K, Çetinkaya Sibel Balcı, Ekinci Miray Kışla, Atmış Bahriye, Barut Kenan, Adrovic Amra, Ağar Buket Esen, Şahin Nihal, Demir Ferhat, Bağlan Esra, Kara Mehtap Akbalık, Selçuk Şenay Zırhlı, Özdel Semanur, Çomak Elif, Akkoyunlu Betül, Yener Gülçin Otar, Yıldırım Deniz Gezgin, Öztürk Kübra, Yıldız Mehmet, Haşlak Fatih, Şener Seher, Kısaoğlu Hakan, Baba Özge, Kızıldağ Zehra, İşgüder Rana, Çağlayan Şengül, Bilgin Raziye B Güven, Aytaç Gülçin, Yücel Burcu Bozkaya, Tanatar Ayşe, Sönmez Hafize E, Çakan Mustafa, Kara Aslıhan, Elmas Ahmet T, Kılıç Beltinge Demircioğlu, Ayaz Nuray Aktay, Kasap Belde, Acar Banu Çelikel, Ozkaya Ozan, Yüksel Selçuk, Bakkaloğlu Sevcan, Aydoğ Özlem, Aksu Güzide, Akman Sema, Dönmez Osman, Bülbül Mehmet, Büyükçelik Mithat, Tabel Yılmaz, Sözeri Betül, Kalyoncu Mukaddes, Bilginer Yelda, Poyrazoğlu Muammer H, Ünsal Erbil, Kasapçopur Özgür, Özen Seza, Düşünsel Ruhan
Аннотация
AIM: To investigate the prevalence, demographic and clinical features, and outcomes of the neurological involvement in the Turkish jSLE population.
METHODS: This study was based upon 24 referral centers' SLE cohorts, multicenter and multidisciplinary network in Turkey. Patient data were collected by a case report form which was standardized for NP definitions according to American Collage of Rheumatology (ACR). Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) neuropsychiatric part was used to determine NP damage. Variables were evaluated Ward's hierarchical clustering analyses, univariate, and multivariate logistic regression analyses.
RESULTS: A hundred forty-nine of 1107 jSLE patients had NP involvement (13.5%). The most common NPSLE findings were headache (50.3%), seizure (38.3%), and acute confusional state (33.6%). Five clusters were identified with all clinical and laboratory findings. The first two clusters involved neuropathies, demyelinating diseases, aseptic meningitis, and movement disorder. Cluster 3 involved headache, activity markers and other SLE involvements. Idiopathic intracranial hypertension, cerebrovascular disease, cognitive dysfunction, psychiatric disorders and SLE antibodies were in the fourth, and acute confusional state was in the fifth cluster. In multivariate analysis, APA positivity; OR: 2.820, (%95CI: 1.002-7.939), P: 0,050, plasmapheresis; OR: 13.804 (%95CI: 2.785-68.432), P: 0,001, SLEDAI scores; OR: 1.115 (%95CI: (1.049-1.186), P: 0,001 were associated with increased risk for neurologic sequelae.
CONCLUSION: We detected the prevalence of juvenile NPSLE manifestations in Turkey. We have identified five clusters that may shed light pathogenesis, treatment and prognosis of NP involvements. We also determined risk factors of neurological sequelae. Our study showed that new definitions NP involvements and sequelae for childhood period are needed.