Studies on Neuropsychiatric SLE

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease that causes damage in multiple organs. Neuropsychiatric symptoms are common in SLE patients and might be a manifestation of nervous system involvement (NPSLE), which is associated with worse prognosis, more cumulative damage and an increase in mortality. A major difficulty in studying NPSLE is the lack of consensus in defining the disease. There is no specific test to diagnose NPSLE and attribution of neuropsychiatric events to SLE activity primarily requires exclusion of secondary causes of neuropsychiatric symptoms. This thesis describes studies on clinical, pathogenetic and imaging aspects of nervous system involvement in patients with SLE. The data presented support the hypothesis that (both antineuronal,- and antiphospholipid) autoantibodies are relevant in the pathogenesis of NPSLE. However, despite the continuous growth in understanding the mechanisms leading to SLE related neuropsychiatric manifestations, NPSLE is a clinical, consensus-based diagnosis, based on an expert multidisciplinary team effort. Using this consensus-based diagnosis of NPSLE as a clinical standard, we showed that new quantitative MRI techniques are likely to help this diagnostic process and also enhance the knowledge of disease pathogenesis. In the future we hope to use quantitative MRI techniques in the routine care of patients with NPSLE.