Objective: To examine the relationship between neuropsychological impairment and antiphospholipid antibody syndrome (aPL syndrome) in patients with systemic lupus erythermatosus (SLE).
Patients: Sixty-nine patients satisfying ACR criteria were studied. Sixteen patients with the aPL syndrome and 53 patients without the syndrome were subjected to eight neuropsychological tests, a physical examination and serological investigations. No patients with other pathology, known to cause acute or chronic impairment of neuropsychological function, were included. Sixty-five underwent MRI scans.
Results: There were no significant differences in age, level of education, incidence of hypertension or disease activity in the two groups. Pearson's correlation coefficients revealed a significant negative correlation with duration of disease in six out of eight tests in the aPL positive group and one out of eight in the aPL negative group. This suggests that aPL syndrome may be involved in the psychological impairment in SLE patients. A larger cohort needs to be studied to confirm this observation.
Hay EM , Black D , Huddy A et al. Psychiatric disorder and cognitive impairment in systemic lupus erythematosus . Arthritis Rheum1992; 35: 411–416 .
2.
Hanly JG , Fisk JD , Sherwood G et al. Cognitive impairment in patients with SLE . J. Rheumatol1992; 19: 562–567 .
3.
Ginsburg KS , Wright EA , Larson MG et al. A controlled study of the prevalence of cognitive dysfunction in randomly selected patients with system lupus erythematosus . Arthritis Rheum1992; 35: 776–782 .
4.
Bluestein HG , Zvaifler NJ . Brain reactive lymphocytotoxic antibodies in the serum of patients with systemic lupus erythematosus . J Clin Invest1976; 57: 509–516 .
5.
Denburg SD , Behmann SA , Carbotte RM et al. Lymphocyte anigens in neuropsychiatric systemic lupus erythematosus . Arthritis Rheum1994; 37: 369–375 .
6.
Bonfa E , Golombek SJ , Kaufman LD et al. Association between Lupus psychosis and antiribosomal P protein antibodies . N Engl J Med1987; 317: 265–271 .
7.
Teh LS , Isenberg DA . Antiribosomal P protein antibodies in systemic lupus erythematosus: a reappraisal . Arthritis Rheum1994; 37: 307–315 .
8.
Hay EM , Huddy A , Black D et al. A prospective study of psychiatric disorder and cognitive function in systemic lupus erythematosus . Ann Rheum Dis1994; 53: 298–303 .
9.
Hugo FJ , Halland AM , Spangenberg J et al. DSM III classification of psychiatric symtpoms in systemic lupus erythematosus . Psychosomatics1996; 37: 262–269 .
10.
Asherson RA , Khamashta MA , Gil A et al. Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome . Amer J Med1989; 86: 391–399 .
11.
Kushner M , Simonian N . Lupus anticoagulants, anticardiolipin antibodies and cerebral Ischemia . Stroke1989; 20: 225–229 .
12.
Asherson RA . Antiphospholipid antibodies and the kidney . J Rheumatol1993; 20: 1268–1271 .
13.
Westerman EM , Miles JM , Backonja M et al. Neuropathologic findings in multi-infarct dementia associated with anticardiolipin antibody . Arthritis Rheum1992; 35: 1038–1041 .
14.
Greisman S , Thayaparon RS , Godwin TA et al. Occlusive vasculopathy in systemic lupus erythematosus . Arch Intern Med1991; 151: 389–392 .
15.
Hess DC , Taormina M , Thompson J et al. Cognitive and neurologic deficits in the MRL/lpr mouse: a clinicopathologic study . J Rheumatol1993; 20: 610–017 .
16.
Sun KH , Liu WT , Tsai CY et al. Inhibition of astrocyte proliferation and binding to brain tissue of anticardiolipin antibodies purified from lupus serum . Ann Rheum Dis1992; 51: 707–712 .
17.
Spangenberg JJ. Neuropsychological impairment in systemic lupus erythematosus. Ph. D. Thesis 1993. Stellenbosch Univsersity.
18.
Carbotte RM , Danburg SD , Danburg JA . Prevalence of cognitive impairment in systemic lupus erythematosus . J Nerv Ment Dis1986; 174: 357–364 .
19.
Harris EN . A reassessment of the antiphospholipid syndrome . J Rheumatol1990; 17: 733–734 .
20.
Last JM . A Dictionary of Epidemiology. 2nd ed.1988, Oxford University Press: New York .
21.
Truedsson L , Sjoholm AG , Laurell AB . Screening for deficiencies in the classical and alternative pathways of complement by haemolysis in gel . APMIS1981; 89: 160–166 .
22.
Cooper RC , Klemp P , Stipp CJ et al. The relationship between anticardiolipin antibodies to disease activity in systemic lupus erythematosus . J Rheumatol1989; 28: 379–382 .
23.
Bombardier C , Gladman DD , Urowitz MB et al. Derivation of the SLEDAI . Arthritis Rheum1992; 35: 630–639 .
24.
Hahn FJY , Rim K . Frontal ventricular dimensions on normal computed tomography . Amer J Radiol1976; 126: 593–596 .
25.
Johnson RT , Richardson EP . The neurological manifestations of systemic lupus erythematosus . Medicine1968; 47: 337–369 .
26.
Ellis SG , Verity A . Central nervous system involvement in systemic lupus erythematosus: a review of neuropathologic findings in 57 cases, 1955–1977 . Semin Arthritis Rheum1979; 8: 212–221 .
27.
Fields RA , Sibbitt WL , Toubbeh H . Neuropsychiatric lupus erythematosus, cerebral infarcts and anticardiolipin antibodies . Ann Rheum Dis1990; 49: 114–117 .
Kuang-Hui S , Wu-Tse L , Chang-Youh T . Inhibition of astrocyte proliferation and binding to brain tissue of anticardiolipin antibodies purified from lupus serum . Ann Rheum Dis1992; 51: 707–712 .
30.
Kent M , Alvarez F , Vogt E et al. Monoclonal antiphosphatidylserine antibodies react directly with Feline and murine central nervous system . J Rheum1997; 24: 1725–1731 .
31.
Hay EM , Hong C , Fisk JD . A five year prospective analysis of cognitive function and anticardiolipin antibodies in SLE . Arthritis Rheum1997; 40: S332-S332 .
32.
Gleason CB , Stoddard MG , Wagener SG et al. A comparison of cardiac valvular involvement in the primary antiphospholipid syndrome versus anticardiolipin-negative systemic lupus erythematosus . Amer Heart J1993, 125: 1123–1129 .
33.
Roldan CA , Shively BK , Crawford MH et al. An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus . N Engl J Med1996; 335: 1424–1430 .
