Neuropsychiatric manifestations in patients with systemic lupus erythematosus: Diagnostic and predictive value of longitudinal examination of anti-ribosomal P antibody

Abstract

Anti-ribosomal P (anti-P) antibodies (IgG, IgA, IgM) were measured by an enzyme-linked immunosorbent assay (ELISA) in serial serum samples from the patients with systemic lupus erythematosus (SLE), and these clinical significance was investigated. Neuropsychi atric manifestations were observed in 24 of 144 patients with SLE. Twelve patients had lupus psychosis, nine convulsion or coma and three primary schizophrenia. In the group with lupus psychosis, serum C3 was significantly higher (p < 0.05) and anti-ds-DNA anti body was significantly lower (p < 0.05) than in the other patients. The titer of anti-P anti bodies was significantly higher in the group with lupus psychosis than that of the other patients. In a longitudinal study, IgA and IgM classes of anti-P antibody were elevated at the onset of psychosis. The titer decreased following a remission of psychosis. Therefore, the measurement of immunoglobulin classes of anti-P antibody will be useful for the diagnosis and follow-up of patients with lupus psychosis.

Keywords

SLE neuropsychiatric manifestation anti-P antibody ELISA longitudinal study

Get full access to this article

View all access options for this article.

References

Gibson T. , Myers AR Nervous system involvement in systemic lupus erythematosus. Ann Rheum Dis 1976; 35: 398-406.

Feinglass EJ et al. Neuro-psychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum and relationship to other features of the disease. Medicine ( Baltimore ) 1976; 55: 323-339.

Bonfa E. , Elkon KB Clinical and serologic associations of the antiribosomal P protein antibody . Arthritis Rheum 1986; 29: 981-985.

Bonfa E. et al. Association between lupus psychosis and antiribosomal P protein antibodies. N Engl J Med 1987; 317: 265-271.

Schneebaum AB et al. Association of psychiatric manifestations with antibodies to ribosomal P proteins in systemic lupus erythematosus. Am J Med 1991; 90: 54-62.

Nojima Y. et al. Correlation of antibodies to ribosomal P protein with psychosis in patients with systemic lupus erythematosus. Ann Rheum Dis 1992; 51: 1053-1055.

Teh LS et al. Antibodies to protein P in systemic lupus erythematosus. Ann Rheum Dis 1992; 51: 489-494.

Elkon KB et al. Identification and chemical synthesis of a ribosomal protein antigenic determinant in systemic lupus erythematosus. Proc Natl Acad Sci USA 1986; 83: 7419-7423.

Tan EM et al. The 1982 revised criteria for classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271-1277.

10.

Avrameas S. Coupling of enzymes to proteins with glutaraldehyde: use of the conjugates for the detection of antigens and antibodies. Immunochemistry 1969; 6: 43-52.

11.

Sato T. et al. Autoantibodies against ribosomal proteins found with high frequency in patients with systemic lupus erythematosus with active disease. J Rheumatol 1991; 18: 1681-1684.

12.

Stafford HA , Anderson CJ , Reichlin M. , Unmasking of antiribosomal P autoantibodies in healthy individuals. J Immunol 1995; 155: 2754-2761.

13.

Jayne Drw et al. Severe pulmonary hemorrhage and systemic vasculitis in association with circulating antineutrophil cytoplasmic antibodies of IgM class only. Clin Nephrol 1989; 32: 101-106.

14.

Bowman C. , Ambrus K. , Lockwood CM Restriction of human IgG subclass expression in the population of autoantibodies to glomerular basement membrane. Clin Exp Immunol 1987; 69: 341-349.

15.

Elkon KB , Bonfa E. , Llovet R. , Eisenberg RA Association between anti-Sm and anti-ribosomal P protein autoantibodies in human systemic lupus erythematosus and MRL/1pr mice. J Immunol 1989; 143: 1549-1554.

16.

Harris EN et al. Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet 1983; 2: 1211-1214.

17.

Van Dam A. et al. Diagnostic value of antibodies against ribosomal phosphoproteins: a cross sectional and longitudinal study. J Rheumatol 1991; 18: 1026-1034.