Central nervous system involvement in systemic lupus erythematosus: cerebral imaging and serological profile in patients with and without overt neuropsychiatric manifestations

The aim of this study was to evaluate morphological and functional abnormal ities by cerebral imaging in a series of systemic lupus erythematosus (SLE) patients with and without overt central nervous system (CNS) manifestation s, and to detect possible relationships with clinical parameters and a larg e panel of autoantibodies, including those reactive against neurotypic and gliotypic antigens. 68 patients with SLE were investigated in a cross-secti onal study which included clinical evaluation of symptoms, cerebral magneti c resonance imaging (MRI) and brain single photon emission tomography (SPEC T) analysis, electroencephalography (EEG), and serological tests for antibo dies directed against nuclear, cytoplasmic neuronal and glial cell-related antigens. The results of this study showed: (1) a significant positive association of (a) anti-glial fibrillary acidic protein (GFAP) serum antibodies with neuro psychiatric (NP) manifestations and (b) anti-serin proteinase 3 (anti-PR3/c -ANCA) serum antibodies with pathological cerebral SPECT; (2) the presence of significantly higher values of(a) SLICC organ damage index in patients w ith abnormal MRI and (b) SLAM activity index in patients with abnormal SPEC T; and (3) the association of (a) abnormal MRI with nonactive NP manifestat ions and (b) combined abnormality of brain SPECT and MRI with the occurrenc e of overall overt NP manifestations and with those of the organic/major ty pe. Neuropsychiatric manifestations, namely those of the organic/major type, ap peared to be significantly associated to the presence of a serum antibody a gainst GFAP, a gliotypic antigen. There was also evidence of an association between SPECT abnormality and the presence of anti-PR3 (c-ANCA). Furthermo re, brain imaging by MRI and SPECT applied to SLE patients appears to expre ss CNS involvement significantly related to specific categories of NP manif estations. The abnormalities detected by the two tests seem to be preferent ially associated with different activity phases of the NP disorder or of th e lupus disease.