B. Kovacs et al., Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature, ANN RHEUM D, 59(2), 2000, pp. 120-124
Objective-To give a comprehensive review of transverse myelopathy (TM), a r
are but serious condition reported in 1-2% of patients with systemic lupus
erythematosus (SLE).
Methods-14 patients with SLE and TM were evaluated and 91 additional cases
published in the English and German literature reviewed.
Results-TM presented either as the initial manifestation or within five yea
rs of the diagnosis of SLE. Most patients presented with a detectable senso
ry deficit at the thoracic level. In our 14 patients, 22% of the patients s
howed complete neurological recovery, whereas in the total patient populati
on of 105 (our cases plus those reviewed in the literature), complete recov
ery was observed in 50%, partial recovery in 29% and no improvement or dete
rioration in 21%. Treatment with intravenous methylprednisolone followed by
cyclophosphamide seemed to be most effective. Seventy per cent of the tota
l patient population had abnormal magnetic resonance imaging findings. In o
ur group of 14 patients, those with higher disease activity (measured by th
e SLAM) at onset of TM were treated more aggressively (for example, with pl
asmapheresis and intravenous pulse cyclophosphamide). TM in our patients wa
s associated with antiphospholipid antibodies in 43% of the cases as compar
ed with 64% of the total patient population. Optic neuritis occurred in 48%
of the total patient population with SLE and TM, suggesting an association
.
Conclusions-TM in SLE is a poorly understood entity. Outcome might be more
favourable than previously suggested. There is an association of TM with an
tiphospholipid antibodies in SLE patients. Treatment including intravenous
cyclophosphamide may improve the final outcome. This report emphasises the
need for multicentre trials to establish guidelines for optimal treatment.