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Lupus affects the brain very early in the disease

Reuters Health • The Doctor's Channel Daily Newscast

By Megan Rauscher

NEW YORK (Reuters Health) – Results of an MRI study suggest that the brain may be affected very early in the course of systemic lupus erythematosus (SLE), “even before the clinical diagnosis of SLE is made,” researchers report in the December issue of the Journal of Rheumatology.

Among a group of 97 patients (94 female; average age, 38) with newly diagnosed SLE, 25% had anatomic brain abnormalities on MRI. All of the patients were within 9 months of being diagnosed with SLE.

These observations indicate that “lupus affects the brain even in newly diagnosed patients,” first author Dr. Michelle Petri of Johns Hopkins University, Baltimore, Maryland, told Reuters Health. “We were shocked actually; we thought it took more time for lupus to involve the brain,” she acknowledged.

Cerebral atrophy, the most common abnormality seen on MRI, was present in 18% of patients with newly diagnosed SLE, and focal lesions were present in 8% of study subjects.

Anxiety disorder was more common in patients with cerebral atrophy (p = 0.04). While anxiety disorder has been frequently seen in SLE patients, it was felt to be a nonspecific finding that did not differ from controls, the authors note. “Our study suggests that there may be a relationship between brain volume loss and anxiety,” they note.

Patients with focal lesions were more likely to be African American (p = 0.045) and had higher SLE disease activity index scores (p = 0.02) and anti-dsDNA (p = 0.05).

Dr. Petri and colleagues conclude: “Given the high frequency of neuropsychiatric SLE manifestations and structural brain abnormalities, more research is urgently needed to determine the underlying pathophysiology of these changes, in order to develop rational treatment options.”

Reference:
J Rheumatol 2008;35:2348-2354.