Neuropsychiatric Symptoms in Chinese Children with Systemic Lupus Erythematosus

Abstract

INTRODUCTION: There is a paucity of clinical studies on children with neuropsychiatric systemic lupus erythematosus (NPSLE).

OBJECTIVE: The objective of this study was to define the clinical characteristics of and the potential predictors for NPSLE in Chinese children.

METHODS: Sixty-two children with SLE diagnosed between 1990 and 2006 were retrospectively reviewed. Patients were evaluated according to the American College of Rheumatology case definitions (1999) for classification of neuropsychiatric symptoms. The demographic data, clinical manifestations, laboratory parameters (complete blood count, erythrocyte sedimentation rate, C-reactive protein, complement levels, anti-cardiolipin antibodies, and autoimmune markers), treatment, and SLE disease activity index score were analyzed.

RESULTS: Nineteen (30.65%) patients with SLE and 21 neuropsychiatric events were identified. Mean age at NPSLE manifestations was 13.57 ± 4.33 years. The most common neuropsychiatric manifestations were cognitive dysfunction (47.62%), seizure disorder (42.86%), and headache (28.57%), followed by mood disorder (19.05%), myelopathy (19.05%), cerebrovascular disease (14.29%), psychosis (9.52%), cranial neuropathy (9.52%), and mononeuropathy multiplex (4.76%). Renal involvement at diagnosis of SLE was significantly less common in patients with NPSLE than in those with non-NPSLE. Apart from that, we could not identify other clinical or laboratory parameters that could predict the development of NPSLE. Six patients presented with neuropsychiatric symptoms at onset of SLE. Comparing them with patients with later neuropsychiatric development, their mean age was younger and the SLE disease activity index score was significantly higher.

CONCLUSIONS: Neuropsychiatric symptoms were common in Chinese children with SLE. Early-onset NPSLE occurred in younger patients with higher disease activity score. Neuropsychiatric development was negatively associated with renal involvement at diagnosis.