Neuropsychiatric syndromes in patients with systemic lupus erythematosus and primary Sjogren syndrome: a comparative population-based study
ABSTRACT To compare the prevalence and pattern of neuropsychiatric (NP) syndromes observed in systemic lupus erythematosus (SLE) to patients with Primary Sjögren syndrome (PSS) using the American College of Rheumatology (ACR) criteria for the 19 NP syndromes seen in SLE.
A population-based study was conducted including 68 patients with SLE (mean (SD) age 43.8 (13.6) years) and 72 with PSS (age 57.8 (13.0) years). Specialists in internal medicine, neurology and neuropsychology performed standardised examinations. Cerebral MRI scans and neurophysiological studies were performed in all patients.
Similar prevalences in SLE and PSS were observed for headaches (87% vs 78%, p = 0.165), cognitive dysfunction (46% vs 50%, p = 0.273), mood disorders (26% vs 33%, p = 0.376), anxiety disorders (12% vs 4%, p = 0.095), cranial neuropathy (1% vs 4%, p = 0.339) and seizure disorders (7% vs 3%, p = 0.208). Cerebrovascular disease was more common in SLE than PSS (12% vs 3%, p = 0.049); but mononeuropathy (0% vs 8%, p = 0.015) and polyneuropathy (18% vs 56%, p<0.001) were less common in SLE than PSS. Other syndromes were rare or absent in both patient groups.
Headache, cognitive dysfunction and mood disorders are common in both diseases, but otherwise there are distinct differences in NP involvement, with cerebrovascular diseases more prevalent in SLE and neuropathies more common in PSS. This indicates that some NP disease mechanisms are shared while others differ between the two diseases.
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ABSTRACT: Objective: Research suggests autoimmune processes to be involved in psychiatric disorders. We aimed to address the prevalence and incidence of autoimmune diseases in a large Finnish patient cohort with anorexia nervosa, bulimia nervosa, and binge eating disorder. Methods: Patients (N = 2342) treated at the Eating Disorder Unit of Helsinki University Central Hospital between 1995 and 2010 were compared with general population controls (N = 9368) matched for age, sex, and place of residence. Data of 30 autoimmune diseases from the Hospital Discharge Register from 1969 to 2010 were analyzed using conditional and Poisson regression models. Results: Of patients, 8.9% vs. 5.4% of control individuals had been diagnosed with one or more autoimmune disease (OR 1.7, 95% CI 1.5-2.0, P<0.001). The increase in endocrinological diseases (OR 2.4, 95% CI 1.8-3.2, P<0.001) was explained by type 1 diabetes, whereas Crohn's disease contributed most to the risk of gastroenterological diseases (OR 1.8, 95% CI 1.4-2.5, P<0.001). Higher prevalence of autoimmune diseases among patients with eating disorders was not exclusively due to endocrinological and gastroenterological diseases; when the two categories were excluded, the increase in prevalence was seen in the patients both before the onset of the eating disorder treatment (OR 1.5, 95% CI 1.1-2.1, P = 0.02) and at the end of the follow-up (OR 1.4, 95% CI 1.1-1.8, P = 0.01). Conclusions: We observed an association between eating disorders and several autoimmune diseases with different genetic backgrounds. Our findings support the link between immune-mediated mechanisms and development of eating disorders. Future studies are needed to further explore the risk of autoimmune diseases and immunological mechanisms in individuals with eating disorders and their family members.PLoS ONE 08/2014; 9(8):e104845. DOI:10.1371/journal.pone.0104845 · 3.53 Impact Factor
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ABSTRACT: Peripheral neuropathy in systemic lupus erythematosus (SLE) is heterogeneous and its commonest pattern is symmetrical polyneuropathy. The aim of this study was to describe the prevalence, clinical and electrophysiological features, disease associations and effects on function and quality of life of polyneuropathy in SLE patients, defined using combined clinical and electrophysiological diagnostic criteria.Lupus 09/2014; 24(3). DOI:10.1177/0961203314552115 · 2.48 Impact Factor
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ABSTRACT: Objective: Cognitive dysfunction is common in both systemic lupus erythematosus (SLE) and primary Sjögren’s Syndrome (pSS). Antibodies against the NR2 subtype of the NMDA-receptor (anti-NR2) cause hippocampal atrophy and cognitive impairment in mice. In humans, these antibodies have been associated with memory impairment in both SLE and pSS patients. In addition, a reduced volume of hippocampal grey matter has been demonstrated in both SLE and pSS patients. However, a connection between the presence of anti-NR2 antibodies and hippocampal atrophy has not been described in human diseases. Methods: A joint cohort of 50 SLE and 50 pSS patients underwent clinical examination and cerebral MRI scanning. We measured anti-NR2 antibodies in cerebrospinal fluid and compared hippocampal grey matter volumes between patients with and without anti-NR2 antibodies. SPM8 software was used for MRI analyses. Results: Patients with anti-NR2 antibodies in cerebrospinal fluid had less hippocampal grey matter than patients without these antibodies. No other differences regarding grey matter volumes in other parts of the brain were revealed. Conclusion: This study indicates that anti-NR2 antibodies cause neuronal death observed as reduced hippocampal grey matter in patients with SLE and pSS as previously demonstrated in mice with autoimmune disease.Arthritis & Rheumatology 01/2014; DOI:10.1002/art.38852 · 7.87 Impact Factor