Transverse Myelitis in Systemic Lupus Erythematosus Clinical Features and Prognostic Factors in a Large Cohort of Latin American Patients

被引：11

作者：

Hernan Chiganer, Edson ^{[1
]}

Flora Lessa, Carmen ^{[1
]}

Luis Di Pace, Jose ^{[2
]}

Beatriz Perassolo, Monica ^{[2
]}

Carnero Contentti, Edgar ^{[3
]}

Alessandro, Lucas ^{[4
]}

Correale, Jorge ^{[4
]}

Fernanda Farfan, Maria ^{[5
]}

Lourdes Galiana, Graciana ^{[5
]}

Sanchez Benavides, Marvin ^{[6
]}

Pacello, Franco ^{[7
]}

Stagno, Mauro ^{[7
]}

Cardozo, Analia ^{[8
]}

Nacimiento Cantero, Maria Belen ^{[8
]}

Elizaur Lopez, Juan Gabriel ^{[9
]}

Daniel Delgadillo, Pedro ^{[9
]}

Melgarejo, Patricia ^{[9
]}

Acosta Colman, Isabel ^{[10
]}

Vazquez Baez, Marcos Aurelio ^{[10
]}

Correa Diaz, Edgar Patricio ^{[11
]}

Jacome Sanchez, Elisa Carolina ^{[11
]}

Alva Linares, Magaly ^{[12
]}

Zamora Tehozol, Erick Adrian ^{[13
]}

Esther Fragoso-Loyo, Hilda ^{[14
]}

Quintanilla-Gonzalez, Lauro ^{[14
]}

De Jesus Batun-Garrido, Jose Antonio ^{[15
]}

Inoue Sato, Emilia ^{[16
]}

Torres do Reis-Neto, Edgard ^{[16
]}

Carreno Nigro, Maria Angela ^{[17
]}

Pablo Hryb, Javier ^{[2
]}

机构：

[1] Hosp Carlos G Durand, Dept Immunol & Histocompatibil, Buenos Aires, DF, Argentina

[2] Hosp Carlos G Durand, Dept Neurol, Buenos Aires, DF, Argentina

[3] Hosp Aleman, Dept Neurosci, Neuroimmunol Unit, Zaragoza, Spain

[4] Fdn Lucha Enfermedades Neurol Infancia, Dept Neurol, Buenos Aires, DF, Argentina

[5] Hosp Luis C Lagomaggiore, Dept Neurol, Mendoza, Argentina

[6] Hosp Rafael Angel Calderon Guardia, Dept Rheumatol, San Jose, Costa Rica

[7] Hosp Galan & Rocha, Dept Internal Med, Paysandu, Uruguay

[8] Hosp Cent Inst Previs Social, Dept Neurol, Asuncion, Paraguay

[9] Hosp Cent Inst Previs Social, Dept Rheumatol, Asuncion, Paraguay

[10] Hosp Clin Univ Nacl Asunc, Dept Rheumatol, Asuncion, Paraguay

[11] Hosp Carlos Andrade Marin, Dept Neurol, Quito, Ecuador

[12] Hosp Nacl Edgardo Rebagliati Martins, Rheumatol Div, Lima, Peru

[13] Hosp Especialidades Ctr Med La Raza, Ctr Med Nacl Siglo XXI, Dept Rheumatol, Mexico City, DF, Mexico

[14] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Immunol & Rheumatol, Mexico City, DF, Mexico

[15] Hosp Alta Especialidad Dr Gustavo A Rovirosa Pere, Dept Internal Med, Villahermosa, Tabasco, Mexico

[16] Univ Fed Sao Paulo, Dept Med, Rheumatol Div, Sao Paulo, Brazil

[17] Clin Las Condes, Dept Rheumatol, Santiago, Chile

来源：

JCR-JOURNAL OF CLINICAL RHEUMATOLOGY | 2021年 / 27卷

关键词：

systemic lupus erythematosus; myelitis; cyclophosphamide; antiphospholipid syndrome; neuromyelitis optica spectrum disorders; NEUROMYELITIS-OPTICA; CLASSIFICATION CRITERIA; NEUROPSYCHIATRIC LUPUS; DISEASE; COMPLEMENT; MYELOPATHY; MANIFESTATIONS; PREVALENCE; VALIDATION; METABOLISM;

D O I：

10.1097/RHU.0000000000001322

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Acute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM. Methods: In this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS). Results: Among patients included, 95%(n = 57) were female, and the average age was 31.6 +/- 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS >= 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS >= 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse. Conclusions: Systemic lupus erythematosus-related ATM may occur at any time of SLE course, leading to significant disability despite treatment.Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors.

引用

页码：S204 / S211

页数：8

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