Predictors of clinical outcome and radiologic progression in patients withneuropsychiatric manifestations of systemic lupus erythematosus

PURPOSE: We sought to identify the predictors of clinical outcome and of th e evolution of cerebral abnormalities in patients with neuropsychiatric sys temic lupus erythematosus (SLE). SUBJECTS AND METHODS: Thirty-two patients with SLE (including 14 with the a ntiphospholipid syndrome) who had been hospitalized with primary neuropsych iatric disease were observed prospectively for at least 2 years. Laboratory and clinical characteristics and data from magnetic resonance imaging (MRI ) studies obtained during the hospitalization and 2 years later were evalua ted. We ascertained nonreversible or new MRI changes and clinical outcomes, including neuropsychiatric events, during follow-up. RESULTS: Cranial MRI scans on admission were abnormal in 26 (81%) of the 32 patients. Patients with the antiphospholipid syndrome were more likely to have focal cerebral white matter lesions (odds ratio [OR] = 12, 95% confide nce interval [CI]: 2.0 to 72). After 2 years, neuropsychiatric deficits sub stantially improved in 22 (69%) of the patients, stabilized in 6 (19%), and deteriorated in 4 (12%). The number of prior neuropsychiatric events was a ssociated with persistent MRI lesions (OR = 4.8 per each event, 95% CI: 1.1 to 21) and unfavorable clinical outcome (OR = 4.3 per each event, 95% CI: 1.4 to 13) at 2 years. The antiphospholipid syndrome also predicted an unfa vorable clinical outcome at 2 years (OR = Il, 95% CI: 1.7 to 65). CONCLUSIONS: Among patients with SLE who have neuropsychiatric disease, pri or neuropsychiatric events and the antiphospholipid syndrome increase the r isk of adverse outcomes. (C) 2000 by Excerpta Medica, Inc.