FRI0364 Neuropsychiatric manifestations in juvenile systemic lupus erythematosus (JSLE)

Abstract

Background The nervous system affects children and adults with systemic lupus erythematosus (SLE) and is associated with a worse prognosis and elevated mortality. In juvenil onset SLE (jSLE) the prevalence of neuropsychiatric manifestations is even more frequently observed when compared to adult onset SLE. Objectives To analyze the prevalence of neuropsychiatric manifestations in jSLE. Methods We conducted a retrospective study including all patients with jSLE followed by the pediatric rheumatology clinic of Unicamp with disease onset before 16 years of age. The neuropsychiatric manifestations were analyzed by reviewing medical records, according to the nomenclature and classification of the American College of Rheumatology (ACR). Neuropsychiatric manifestations were considered present at disease onset when they occurred in the first six months of disease and during evolution, when occurred after this period. Results We included 66 patients (62 women) with mean age of 17.77 years (SD ± 4.55). At disease onset, a total of 46 neuropsychiatric manifestations were observed in 35 (53.03%) patients. The manifestations more frequently observed at disease onset were: headache (42.42%), seizures (16.66%), psychosis (4.54%), depression (3.03%), acute confusional state (1.51%) and chorea (1.51%). During the follow-up period, 99 neuropsychiatric manifestations were observed in 46 (69.69%) patients. The neuropsychiatric manifestations more frequently observed were headache (43.93%), cognitive impairment (36.66%), anxiety (31.81%), depression (19.69%), seizures (7.57%), psychosis (3.03%), acute confusional state (3.03%), chorea (1.51%) and polyneuropathy (1.51%). Thirteen (19.69%) patients never had neuropsychiatric manifestations during the course of the disease and twenty-eight (42.42%) patients had recurrent neuropsychiatric manifestations. Six (9.09%) patients had recurrent seizures. There were no cases of transverse myelitis in this series. Conclusions The neuropsychiatric manifestations are frequently observed in patients with jSLE, however 20% of jSLE patients never had any neuropsychiatric manifestation during the follow-up period. Central nervous system manifestations were more frequently observed than manifestations affecting the peripheral nervous system. Most patients had recurrent neuropsychiatric manifestations. References ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42:599-608. Castellano G, Bonilha L, Li LM, Cendes F. Texture analysis of medical images. Clin Radiol. 2004;59:1061-1069. Appenzeller S, Vasconcelos FA, Li LM, Costallat LT, Cendes F. Quantitative magnetic resonance imaging analyses and clinical significance of hyperintense white matter lesions in systemic lupus erythematosus patients. Ann Neurol. 2008;64:635-643 Disclosure of Interest A. Lapa Grant/Research support from: FAPESP 2010/13639-1, M. Postal Grant/Research support from: FAPSEP 2009/10744-1, N. Sinicato Grant/Research support from: FAPESP 2010/13637-9, L. Silveira Grant/Research support from: FAPSEP 2010/11923-4, A. Ferrari Grant/Research support from: FAPSEP 2011/13905-6, R. Marini: None Declared, S. Appenzeller Grant/Research support from: FAPESP 2008/02917-0; Conselho Nacional Pesquisa Desenvolvimento-Brasil CNPq (300447/2009-4)