NEUROPSYCHIATRIC SYSTEMIC LUPUS-ERYTHEMATOSUS BEFORE AND AFTER IMMUNOSUPPRESSIVE TREATMENT - A FDG PET STUDY

At its inception, morphological imaging, like magnetic resonance imagi ng (MRI), is often not useful in neuropsychiatric systemic lupus eryth ematosus (NPSLE), although the disease clinically shows cerebral sympt oms. Functional imaging, like positron emission tomography (PET), may be a method that offers some advantages. We report a 53-year-old white man with decreased memory and visual disturbances who met four of the American Rheumatism Association (ARA) criteria for the classification of SLE. He was investigated before and after 3 months of therapy usin g PET and F-18-fluoro-2-deoxy-D-glucose (FDG). Treatment consisted of prednisone (25 mg/day, tapered to 10 mg/day) and cyclophosphamide (dai ly 100 mg for 3 weeks followed by a drug-free interval of 1 week). For the control group, 15 clinically and neurologically healthy volunteer s (5 male, 10 female, aged 48 +/- 7 years) were investigated. All stud y participants additionally had a cranial MRI. Ln both controls and th e SLE patient, cranial MRI was negative. However, the patient showed a significant hypometabolism in the region parieto-occipital on both si des and the parietal region on the right side before treatment. After treatment metabolism in these regions was within normal limits. Hence, FDG-PET could help to verify brain-onset of SLE earlier and may be a powerful tool for controlling SLE treatment.