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Nervous System Disease in Systemic Lupus Erythematosus: Current Status and Future Directions
Author(s) -
Hanly John G.,
Kozora Elizabeth,
Beyea Steven D.,
Birnbaum Julius
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40591
Subject(s) - medicine , neuroimaging , disease , comorbidity , proinflammatory cytokine , autoantibody , neurology , rheumatology , immunology , intensive care medicine , bioinformatics , inflammation , psychiatry , antibody , biology
The American College of Rheumatology's case definitions for 19 neuropsychiatric syndromes in systemic lupus erythematosus ( SLE ) constitute a comprehensive classification of nervous system events in this disease. However, additional strategies are needed to determine whether a neuropsychiatric syndrome is attributable to SLE versus a competing comorbidity. Cognitive function is a clinical surrogate of overall brain health, with applications in both diagnosis and determination of clinical outcomes. Ischemic and inflammatory mechanisms are both key components of the immunopathogenesis of neuropsychiatric SLE ( NPSLE ), including abnormalities of the blood–brain barrier and autoantibody‐mediated production of proinflammatory cytokines. Advances in neuroimaging provide a platform to assess novel disease mechanisms in a noninvasive way. The convergence of more rigorous clinical characterization, validation of biomarkers, and brain neuroimaging provides opportunities to determine the efficacy of novel targeted therapies in the treatment of NPSLE .