PROSPECTIVE-STUDY OF NEUROPHYSIOLOGIC, NEUROLOGIC AND IMMUNOLOGICAL ABNORMALITIES IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Objective. To describe neurologic and neurophysiologic (NP) outcome in patients with systemic lupus erythematosus (SLE) followed prospective ly and to determine predictors of change in NP status. Methods. Clinic al examination, laboratory and NP tests (brain stem auditory and visua l evoked responses, peripheral nerve conduction studies) were performe d in 18 unselected patients with SLE attending a general rheumatology clinic at enrollment into the study (baseline) and after a 2-year (mea n) period of followup. Results. Fifty percent (9/18) and 83% (15/18) o f patients had neurological abnormalities at baseline and followup, re spectively, the most common of which were headache and peripheral neur opathy. NP abnormalities were found in 56% (10/18) and 61% (11/18) of patients at baseline and followup. The most frequent abnormalities at both visits were of peripheral nerve conduction [33% (6/18) and 56% (1 0/18), respectively] and abnormalities of brainstem and/or visual evok ed responses were found in 28% (5/18) and 22% (4/18) of patients at bo th visits. At baseline, vasculitis was significantly increased in pati ents with NP abnormalities (p = 0.04). NP status deteriorated between visits in 8 patients (44%), 6 of whom acquired peripheral abnormalitie s. Improvement in NP status was only noted in patients (2/18, 11%) who had NP abnormalities restricted to the central nervous system. Associ ations were seen between elevated dsDNA antibodies, vasculitis, and ly mphopenia, and the risk of acquiring new NP abnormalities. Conclusion. Patients with SLE had many neurological and NP abnormalities. NP defi cits acquired were most often of peripheral nerve conduction. The abil ity to identify and classify clinical and subclinical neurological abn ormalities in patients with SLE using NP tests may enhance our underst anding and management of their neurological disease.