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.

Regional Brain Diffusion Abnormalities in Systemic Lupus Erythematosus.

Appenzeller3,  Simone, Rittner4,  Leticia, Leonard1,  Gabriel, Vielleux2,  Martin, Pike1,  Bruce, Clarke1,  Ann

McGill University, Canada
McGill University, Canada
State University of Campinas, Brazil
State University of Campinas, Brazil


To determine regional brain diffusion abnormalities and to evaluate the relationship between diffusion parameters [fraction anisotropy (FA) and mean diffusivity (MD)] and cognitive impairment and mood disorders in systemic lupus erythematosus (SLE).


We screened consecutive female SLE patients followed in a longitudinal cohort between 2007/2008. We excluded patients with any factors associated with cerebral atrophy or vasculopathy [i.e., age >= 50 years, hypertension, renal insufficiency, transient ischemic attack or stroke, scleroderma features, diabetes, drug abuse, or malignancy] or not educated primarily in English or French. Healthy age-matched women were selected as controls. All underwent a standardized neuropsychological evaluation assessing the following: simple attention, complex attention, memory, visuospatial processing, language, reasoning/problem solving, psychomotor speed, and executive functions. Individual results were converted into standard scores and compared to normative data. Subjects with a total score in any of the 8 domains <=2 SD below the normative value were considered impaired. Mood disorders were determined by Becks Depression and Becks Anxiety Inventory (BDI and BAI). Magnetic resonance imaging (MRI) was performed on a Siemens 3 Tesla scanner and volumetric T1, T2 and PD weighted images were used for automatic segmentation of the brain. Diffusion images were acquired in 63 directions (b=1000s/mm2; TR=10900ms; TE=105ms; FOV=256mm). Brain regions of interest (ROI) were overlaid to the diffusion images acquired and FA and MD were calculated for each structure. The FA and MD values were compared between groups using the t-test. Correlation between cognitive impairment, mood disorders and FA and MD was assessed through the Pearson correlation.


Twenty-seven patients (mean age 34.08, SD 8.85) and ten controls (mean age 33, SD 8.3) were included. We observed significantly lower FA and higher MD in SLE when compared to controls in the following white matter structures: bilateral frontal lobe (p=0.01), right temporal lobe (p=0.031), bilateral parietal lobe (p=0.02), in addition to bilateral amigdala (p=0.005) and the thalamus (p=0.01). No difference between diffusion parameters were observed in the hippocampus, left frontal lobe, occipital lobes, cerebellum, corpus callosum, caudate, putamen and parahippocampal region. FA and MD of the amigdalacorrelated with the severity of anxiety (r=0.7; p=0.001) and FA and MD of the frontal lobe with cognitive impairment (r=0.56; p=0.03).


Diffusion abnormalities are not uniform in SLE patients. Increased MD and reduced FA, indicating reduction in myelination and axonal damage were observed in frontal, temporal, parietal white matter and in the amigdala. The severity of anxiety and the presence of cognitive impairment correlated with axonal damage in the amigdala and in the frontal lobe white matter. Diffusion parameters can be used to evaluate SLE patients with central nervous system manifestations and visually normal MRIs.

To cite this abstract, please use the following information:
Appenzeller, Simone, Rittner, Leticia, Leonard, Gabriel, Vielleux, Martin, Pike, Bruce, Clarke, Ann; Regional Brain Diffusion Abnormalities in Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1170
DOI: 10.1002/art.28936

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