Neuropsychiatric lupus: new mechanistic insights and future treatment directions

Noa Schwartz, Ariel D. Stock, Chaim Putterman

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Patients with systemic lupus erythematosus (SLE) frequently show symptoms of central nervous system (CNS) involvement, termed neuropsychiatric SLE (NPSLE). The CNS manifestations of SLE are diverse and have a broad spectrum of severity and prognostic implications. Patients with NPSLE typically present with nonspecific symptoms, such as headache and cognitive impairment, but might also experience devastating features, such as memory loss, seizures and stroke. Some features of NPSLE, in particular those related to coagulopathy, have been characterized and an evidence-based treatment algorithm is available. The cognitive and affective manifestations of NPSLE, however, remain poorly understood. Various immune effectors have been evaluated as contributors to its pathogenesis, including brain-reactive autoantibodies, cytokines and cell-mediated inflammation. Additional brain-intrinsic elements (such as resident microglia, the blood–brain barrier and other neurovascular interfaces) are important facilitators of NPSLE. As yet, however, no unifying model has been found to underlie the pathogenesis of NPSLE, suggesting that this disease has multiple contributors and perhaps several distinct aetiologies. This heterogeneity presents a challenge for clinicians who have traditionally relied on empirical judgement in choosing treatment modalities for patients with NPSLE. Improved understanding of this manifestation of SLE might yield further options for managing this disease.

Original languageEnglish (US)
JournalNature Reviews Rheumatology
DOIs
StateAccepted/In press - Jan 1 2019

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Systemic Lupus Erythematosus
Central Nervous System
Central Nervous System Lupus Vasculitis
Neurobehavioral Manifestations
Memory Disorders
Brain
Microglia
Autoantibodies
Headache
Seizures
Therapeutics
Stroke
Cytokines
Inflammation
Direction compound
Cognitive Dysfunction

ASJC Scopus subject areas

  • Rheumatology

Cite this

Neuropsychiatric lupus : new mechanistic insights and future treatment directions. / Schwartz, Noa; Stock, Ariel D.; Putterman, Chaim.

In: Nature Reviews Rheumatology, 01.01.2019.

Research output: Contribution to journalArticle

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