Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Peripheral Neuropathy in Patients with Systemic Lupus Erythematosus.
Florica2, Brandusa, Su1, Jiandong, Aghdassi1, Ellie, Gladman1, Dafna D., Urowitz1, Murray B., Fortin1, Paul R.
Peripheral neuropathy (PN) is a common feature of neuropsychiatric syndromes in Systemic Lupus Erythematosus (SLE) that can affect the quality of life of these patients. Currently the studies describing the clinical features of SLE patients with PN are scarce.
To determine in SLE patients: 1) the prevalence, the clinical course of PN and the impact on quality of life, 2) the clinical features and sub-classes of PN, and 3) whether there is an association between PN and any other clinical feature.
Patients who met at least 4 of the ACR classification criteria and met the ACR case definition criteria for peripheral neurological SLE were selected from the database registry of the University of Toronto Lupus Clinic. Chart review was performed to confirm clinical findings, determine the contributing factors and outcome of PN. PN found to be due to non-SLE causes were analyzed but kept in a separate group than SLE-related PN. Demographic data including age, gender and SLE duration, as well as SLE related clinical and investigational data at the time of the first appearance of PN were extracted by chart review. Disease activity and damage were assessed by SLE- Disease Activity Index (SLEDAI-2K) and SLICC Damage Index (SDI) at the time of the first appearance of PN. Quality of life was determined using the SF-36 questionnaire and scored for the physical (PCS) and mental (MCS) component summary scores. Data were analyzed using SAS statistical program.
Out of 1520 patients in the database, 210 (14%) with a mean (SD) ACR criteria of 5.7 (2.0) met the inclusion criteria. Subjects had mean (SD) for age of 44 (14.4) years and SLE duration of 9.2 years (10.2); median (IQR) for SLEDAI of 6.0 (IQR: 2.0, 12.0) and SDI of 1.0 (IQR: 0.0, 2.0); and 86.6% were female. Among patients, 66.9% had at least one SLE-related or possible SLE-related PN including mononeuritis multiplex (14.2%), sensory PN (27%) and mononeuropathy (25.8% including cranial neuropathy in 7.4%). Asymmetric presentation was most common (62.8%), and distal weakness occurred in 31.8% of patients. Peroneal nerve (61.4%), sural nerve (51.8%) and median nerve (40.9%) were frequently involved. Associated SLE features were: 85% arthritis, 69.3% rash, 47.8% CNS involvement. ANA titer of 1:320 or higher was significantly more prevalent in patients with SLE-related PN than non-SLE related PN (43.5% vs. 21.4%; p=0.028). EMG/NCS was performed in 67.7% of patients and indicated axonal neuropathy in 76.8% and demyelination in 18.3% of patients. Treatment included oral steroid in 85.4%, cyclophosphamide in 19.3% and pulse steroids in 7.9 % of patients. Chart review completed in 130 of the patients, showed that 67.7% of patients improved and 28.4% had no response to treatment, within a mean (SD) follow up period of 5.4 (7.6) years. SF-36 PCS was low in those with PN with a mean (SD) of 35.8 (10.7).
PN is relatively prevalent in SLE, may occur at any time after SLE diagnosis and with different presentations. This manifestation of SLE has a big impact on patient's quality of life.
To cite this abstract, please use the following information:
Florica, Brandusa, Su, Jiandong, Aghdassi, Ellie, Gladman, Dafna D., Urowitz, Murray B., Fortin, Paul R.; Peripheral Neuropathy in Patients with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1165