Autoantibodies and neuropsychiatric events at the time of systemic lupus erythematosus diagnosis

被引：133

作者：

Hanly, J. G. ^{[1
,2
]}

Urowitz, M. B. ^{[3
,4
]}

Siannis, F. ^{[5
]}

Farewell, V. ^{[6
]}

Gordon, C. ^{[7
]}

Bae, S. C. ^{[8
]}

Isenberg, D. ^{[9
]}

Dooley, M. A. ^{[10
]}

Clarke, A. ^{[11
,12
]}

Bernatsky, S. ^{[11
,12
]}

Gladman, D. ^{[3
,4
]}

Fortin, P. R. ^{[3
,4
]}

Manzi, S. ^{[13
]}

Steinsson, K. ^{[14
]}

Bruce, I. N. ^{[15
,16
]}

Ginzler, E. ^{[17
]}

Aranow, C. ^{[18
]}

Wallace, D. J. ^{[19
]}

Ramsey-Goldman, R. ^{[20
]}

van Vollenhoven, R. ^{[21
]}

Sturfelt, G. ^{[22
]}

Nived, O. ^{[22
]}

Sanchez-Guerrero, J. ^{[23
]}

Alarcon, G. S. ^{[24
]}

Petri, M. ^{[25
]}

Khamashta, M. ^{[26
,27
]}

Zoma, A. ^{[28
]}

Font, J.

Kalunian, K. ^{[29
]}

Douglas, J. ^{[1
,2
]}

Qi, Q. ^{[1
,2
]}

Thompson, K. ^{[1
,2
]}

Merrill, J. T. ^{[30
]}

机构：

[1] Nova Scotia Rehabil Ctr, Div Rheumatol, Queen Elizabeth II Hlth Ctr, Halifax, NS B3H 4K4, Canada

[2] Dalhousie Univ, Halifax, NS, Canada

[3] Toronto Western Hosp, Toronto, ON M5T 2S8, Canada

[4] Univ Toronto, Toronto, ON, Canada

[5] Univ Athens, Athens, Greece

[6] Cambridge Univ Forvie Site, Cambridge, England

[7] Univ Birmingham, Birmingham, W Midlands, England

[8] Royal Natl Hosp Rheumat Dis, Seoul, South Korea

[9] UCL, London, England

[10] Univ N Carolina, Chapel Hill, NC USA

[11] Montreal Gen Hosp, Montreal, PQ H3G 1A4, Canada

[12] McGill Univ, Ctr Hlth, Montreal, PQ, Canada

[13] Univ Pittsburgh, Sch Med, Pittsburgh, PA USA

[14] Landspitali Univ Hosp, Reykjavik, Iceland

[15] Manchester Royal Infirm, Manchester M13 9WL, Lancs, England

[16] Univ Manchester, Manchester M13 9WL, Lancs, England

[17] SUNY Hlth Sci Ctr, Brooklyn, NY 11203 USA

[18] Columbia Univ, Med Ctr, New York, NY USA

[19] Univ Calif Los Angeles, Los Angeles, CA USA

[20] Northwestern Univ, Chicago, IL 60611 USA

[21] Karolinska Univ Hosp, Stockholm, Sweden

[22] Univ Lund Hosp, S-22185 Lund, Sweden

[23] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico

[24] Univ Alabama Birmingham, Birmingham, AL USA

[25] Johns Hopkins Univ, Baltimore, MD USA

[26] St Thomas Hosp, London, England

[27] Kings Coll London, London WC2R 2LS, England

[28] Hairmyres Hosp, E Kilbride, Lanark, Scotland

[29] Univ Calif San Diego, San Diego, CA 92103 USA

[30] Oklahoma Med Res Fdn, Oklahoma City, OK USA

来源：

ARTHRITIS AND RHEUMATISM | 2008年 / 58卷 / 03期

基金：

英国惠康基金; 英国医学研究理事会;

关键词：

D O I：

10.1002/art.23218

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective. To examine, in an inception cohort of systemic lupus erythematosus (SLE) patients, the association between neuropsychiatric (NP) events and anti-ribosomal P (anti-P), antiphospholipid (lupus anticoagulant [LAC], anticardiolipin), anti-beta 2-glycoprotein I, and anti-NR2 glutamate receptor antibodies. Methods. NP events were identified using the American College of Rheumatology case definitions and clustered into central/peripheral and diffuse/focal events. Attribution of NP events to SLE was determined using decision rules of differing stringency. Autoantibodies were measured without knowledge of NP events or their attribution. Results. Four hundred twelve patients were studied (87.4% female; mean +/- SD age 34.9 +/- 13.5 years, mean +/- SD disease duration 5.0 +/- 4.2 months). There were 214 NP events in 133 patients (32.3%). The proportion of NP events attributed to SLE varied from 15% to 36%. There was no association between autoantibodies and NP events overall. However, the frequency of anti-P antibodies in patients with central NP events attributed to SLE was 4 of 20 (20%), versus 3 of 107 (2.8%) in patients with other NP events and 24 of 279 (8.6%) in those with no NP events (P = 0.04). Among patients with diffuse NP events, 3 of 11 had anti-P antibodies (27%), compared with 4 of 111 patients with other NP events (3.6%) and 24 of 279 of those with no NP events (8.6%) (P 0.02). Specific clinical-serologic associations were found between anti-P and psychosis attributed to SLE (P = 0.02) and between LAC and cerebrovascular disease attributed to SLE (P = 0.038). There was no significant association between other autoantibodies and NP events. Conclusion. Clinically distinct NP events attributed to SLE and occurring around the time of diagnosis were found to be associated with anti-P antibodies and LAC. This Suggests that there are different autoimmune pathogenetic mechanisms, although low sensitivity limits the clinical application of testing for these antibodies.

引用

页码：843 / 853

页数：11

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