Access: Lupus Research -- Neuropsychiatric Lupus
Research Summaries from 2012
Long-Term Outcomes of Neuropsychiatric Lupus
Neuropsychiatric lupus (NPSLE) includes a wide variety of neurological and psychiatric symptoms which are known to significantly impact short-term disease- and health-related outcomes. These include effects on organ damage, fatigue, employment status, and quality of life. While the negative short-term effects of NPSLE are well-known, the long-term effects have been less thoroughly documented. The results of this study highlight the long-term effects of early NPSLE-related events on organ damage and recurrences of NPSLE-related events over time, in those having NPSLE-related events around the time of lupus diagnosis. The findings also suggest that NPSLE-related events may occur in greater isolation than other kinds of lupus complications.
Research Summaries from 2011
Heart Disease May Precipitate Depression in Certain People with Lupus
Depression occurs commonly in people with lupus, as does heart disease. However, it is unknown whether one may trigger or contribute to the development of the other. Increased understanding of factors that may contribute to depression in people with lupus can aid future strategies to prevent and treat depression in people with lupus. The researchers hoped to learn about lupus-related factors that may contribute to the development of depression in people with lupus. The participants were interviewed annually about their health statuses for up to five years. The researchers used statistical methods to determine whether specific lupus-related factors could predict the development of another. The following were found to be predictors of depression in people with lupus regardless of the statistical methods used: being aged 40-59, having less than a full college education, being Hispanic/Latino, and having some form of depression upon entry to the study. Increased education seems to have a protective effect against developing depression in people with lupus. Identifying lupus patients at risk for developing depression could greatly increase their quality of life since there are many effective treatment options for depression.
Validation of a Self-Reported Questionnaire for Neuropsychiatric Lupus Events
The incidence of neuropsychiatric disease in people with lupus varies widely, from 21% to 95%, depending on the stringency of the criteria used. Regardless, it is recognized that the occurrence of neuropsychiatric disease is associated with reduced self-reported quality of life in people with lupus. The use of standardized measures of health-related quality of life associated with neuropsychiatric events in people with lupus has not yet been validated. The investigators sought to examine changes in health-related quality of life associated with clinical outcomes of neuropsychiatric events in people with lupus over the course of one year. Health-related quality of life was determined for each patient by use of the Short Form 36 (SF-36), a questionnaire which includes components about both mental and physical status. The results of the SF-36 self-reports were compared to physician-determined assessments of the patients’ neuropsychiatric statuses. The most frequent neuropsychiatric events included the following: headache, mood disorders, cognitive dysfunction, anxiety disorder, cerebrovascular disease, multiple kinds of nerve inflammation, and seizures. Physician-determined changes in the neuropsychiatric statuses of patients were significantly similar to SF-36 self-reports provided by patients. The SF-36 thus appears to be a valid measure of changes in neuropsychiatric status in people with lupus that may complement other kinds of tests.
Blood Test for Antibodies That Might be Associated with Risk for Lupus Brain Inflammation
A protein in the brain called NR2A is part of a system that is important for learning and memory. Lupus patients can make antibodies to NR2A and some, but not all, studies have suggested that there might be a relationship between these antibodies and lupus brain inflammation (also known as neuropsychiatric lupus or NPSLE). The researchers studied the relationship between anti-NR2A antibodies and different aspects of lupus, especially whether there might be a relationship between these antibodies and NPSLE in patients from Japan.
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New Combination of Antibodies May Better Predict Childhood Neuropsychiatric Lupus
Neuropsychiatric lupus (NPSLE) is difficult to diagnose and can be present when disease activity in other organs cannot be identified. The researchers hoped to learn whether antibodies to ganglioside M1, a fat found throughout the brain, could predict childhood NPSLE any better than standard laboratory measures currently in use. At the time of initial evaluation (and before NPSLE developed), 83% and 50% of children who later developed NPSLE had anti-ganglioside M1 and anti-ribosomal P antibodies, respectively. None of the 18 patients who did not develop NPSLE had either one of these antibodies. This study suggests that anti-ganglioside M1 antibodies might help to predict NPSLE in children with lupus, especially when paired with anti-ribosomal P antibodies.
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Research Summaries from 2010
Brain Involvement in an International Cohort of Lupus Patients
The reported frequency of “neuropsychiatric lupus” (NPL) (brain inflammation) varies widely, from 37% to 95%, in people with lupus, but severe inflammation of the brain is quite rare. The high degree of complications and variability reported across studies stems largely from differences in definitions used in studies of NPL. In addition, some studies have lacked consistency in determining if the events are related to lupus. This ongoing study will follow people with newly diagnosed lupus over 10 years and researchers hope to accurately determine the frequency and outcome of NPL, as well as its impacts on quality of life.
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Can Blood Tests Help Us Learn about CNS Lupus (Lupus and the Brain)?
Some people with lupus can develop mild or, more rarely, severe inflammation of the brain, also called Central Nervous System lupus (CNS lupus). Very rarely, people can develop serious problems from CNS lupus such as seizures or strokes. Sometimes it is hard to know the difference between CNS lupus and problems that might be due to fatigue, depression, or migraine headaches. Therefore, it would be helpful to have blood tests that could tell the difference, so appropriate treatments could be given.
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Research Summaries from 2007
Particular immune molecules and NPSLE
Despite the fact that a significant percentage of lupus patients (estimates run from 14% to 75%) have signs of neurological involvement, doctors still don't have a single test that can definitely indicate when lupus is affecting the central nervous system (NPSLE). The researchers sought to determine if the presence of particular factors in the spinal fluid (CSF) of lupus patients are associated with NPSLE, which might help determine NPSLE diagnosis. The researchers found increased concentrations of several inflammatory proteins in the CSF of lupus patients during a flare of NPSLE including interleukin 6 (IL-6) and several other proteins.
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Results of preliminary study of rituximab for difficult NPSLE
Lupus may affect the central nervous system (NPSLE), with estimates varying widely (from 12% to 75%) for the number of lupus patients who experience minor or moderate flares in the nervous system. Researchers from Japan found that the cancer drug rituximab was effective in treating the NPSLE symptoms in a small group of 10 patients.
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