The significance of cerebrospinal fluid examination in neuropsychiatric systemic lupus erythematosus


Authors: V. Balajková;  M. Olejárová
Authors‘ workplace: Revmatologický ústav, Praha ;  Revmatologická klinika 1. LF UK, Praha
Published in: Čes. Revmatol., 26, 2018, No. 1, p. 23-33.
Category: Review Article

Overview

Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious complication of this disease which significantly degrades the quality of life of the patient. This is one of the most complex manifestations of systemic lupus, which can affect the central, peripheral and autonomic nervous system. The exact pathophysiology of this disease is not known yet, neither is a specific biomarker for its detection. The neurological examination of cerebrospinal fluid has received more attention in recent years, especially in the NPSLE diagnostic algorithm. Besides standard cytological, biochemical and immunological examinations, it also offers the possibility of detection of autoantibodies, inflammatory mediators and blood-brain barrier disorders.

The aim of this work is to summarize the most frequent findings in patients with neuropsychiatric involvement in systemic lupus erythematosus. The most common type of cellular response in NPSLE is mild pleocytosis with a majority of lymphocytes, and neutrophilic granulocytosis in transverse myelitis. In the biochemical examination of the cerebrospinal fluid, in up to half of the cases the total protein and the albumin quotient were increased, indicating damage to the blood-brain barrier. A frequent finding is also an increase in the IgG index and detection of intrathecal oligoclonal IgG synthesis. Of the pro-inflammatory cytokines, IL-6 and IL-8 are present in most cases of NPSLE. Proteins that are associated with NPSLE include anti-RP, anti-N, anti-U1RNP and anti-Sm antibodies.

Key words:
neuropsychiatric systemic lupus erythematosus, cerebrospinal fluid


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