Öz
Objective: Neuropsychiatric (NP) involvement in juvenile onset systemic lupus erythematosus (jSLE) is associated with increased morbidity and diagnostic challenges. Data regarding pediatric populations remain limited. This study aimed to determine the prevalence, clinical features, imaging findings, and treatment outcomes of neuropsychiatric SLE (NPSLE) at a tertiary pediatric rheumatology center.
Materials and Methods: This retrospective study included 46 jSLE patients followed between 2015 and 2025. Patients were classified as NPSLE or non-NPSLE. Demographic, clinical, laboratory, imaging, and treatment data were analyzed.
Results: NPSLE was identified in 14 (30.4%) patients, and it was predominantly observed at disease onset. Patients with NPSLE had significantly higher disease activity at the time of diagnosis (p=0.001). Seizures (n=5, 10.8%) and depression (n=2, 4.3%) were the most common symptoms. Anti-ribosomal P antibody positivity was more common in NPSLE patients (p=0.019). Macrophage activation syndrome was observed in 3 (6.5%) patients, all of whom were in the NPSLE group. All patients received corticosteroids and hydroxychloroquine, and most were treated with cyclophosphamide. At the final follow-up, disease activity had significantly decreased, and most patients achieved low disease activity without neurological sequelae.
Conclusion: NPSLE is a common and severe manifestation of jSLE and is associated with high disease activity. Early and aggressive immunosuppressive therapy may play a critical role in controlling disease activity and improving prognosis.
Kaynakça
- Couture J, Silverman ED. Update on the pathogenesis and treatment of childhood-onset systemic lupus erythematosus. Curr Opin Rheumatol 2016; 28 (5): 488-96. https://doi.org/10.1097/BOR.0000000000000317
- Pineles D, Valente A, Warren B, Peterson MG, Lehman TJ, Moorthy LN. Worldwide incidence and prevalence of pediatric onset systemic lupus erythematosus. Lupus 2011; 20(11): 1187-92. https://doi.org/10.1177/0961203311412096
- Hiraki LT, Feldman CH, Liu J, et al. Prevalence, incidence, and demographics of systemic lupus erythematosus and lupus nephritis from 2000 to 2004 among children in the US Medicaid beneficiary population. Arthritis Rheum 2012; 64(8): 2669-76. https://doi.org/10.1002/art.34472
- Artim-Esen B, Şahin S, Çene E, et al. Comparison of disease characteristics, organ damage, and survival in patients with juvenile-onset and adult-onset systemic lupus erythematosus in a combined cohort from 2 tertiary centers in Turkey. J Rheumatol 2017; 44(5): 619-25. https://doi.org/10.3899/jrheum.160340
- Sahin S, Adrovic A, Barut K, et al. Juvenile systemic lupus erythematosus in Turkey: demographic, clinical and laboratory features with disease activity and outcome. Lupus 2018; 27(3): 514-9. https://doi.org/10.1177/0961203317747717
- Santos FPST, Nascimento BR, Calderaro DC, Ferreira GA, Correa H. Neuropsychiatric syndromes in childhood-onset systemic lupus erythematosus: a systematic review and meta-analysis. J Clin Rheumatol 2021; 27(5): 206-14. https://doi.org/10.1097/RHU.0000000000001029
- The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42(4): 599-608. https://doi.org/10.1002/1529-0131(199904)42:4<599::AID-ANR2>3.0.CO;2-F
- Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: pathogenesis and biomarkers. Nat Rev Neurol 2014; 10: 579-96. https://doi.org/10.1038/nrneurol.2014.148
- Khajezadeh MA, Zamani G, Moazzami B, Nagahi Z, Mousavi-Torshizi M, Ziaee V. Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus. Neurol Res Int 2018; 2018(1): 2548142. https://doi.org/10.1155/2018/2548142
- Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64(8): 2677-86. https://doi.org/10.1002/art.34473
- Weening JJ, D’Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15(2): 241-50. https://doi.org/10.1097/01.asn.0000108969.21691.5d.
- Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29: 288-91.
- Jesus D, Rodrigues M, Matos A, Henriques C, Pereira da Silva JA, Inês LS. Performance of SLEDAI-2K to detect a clinically meaningful change in SLE disease activity: a 36-month prospective cohort study of 334 patients. Lupus 2019; 28(5): 607-12. https://doi.org/10.1177/0961203319836717
- Ugarte-Gil MF, Gamboa-Cárdenas RV, Reátegui-Sokolova C, et al. Better health-related quality of life in systemic lupus erythematosus predicted by low disease activity state/remission: data from the Peruvian Almenara Lupus Cohort. Arthritis Care Res (Hoboken) 2020; 72(8): 1159-62. https://doi.org/10.1002/acr.24009
- Carrión-Barberà I, Salman-Monte TC, Vílchez-Oya F, Monfort J. Neuropsychiatric involvement in systemic lupus erythematosus: a review. Autoimmun Rev 2021; 20(4): 102780. https://doi.org/10.1016/j.autrev.2021.102780
- Balci S, Ekinci RMK, Bayazit AK, et al. Juvenile systemic lupus erythematosus: a single-center experience from southern Turkey. Clin Rheumatol 2019; 38: 1459-68. https://doi.org/10.1007/s10067-019-04433-4
- Kısaarslan AP, Çiçek SÖ, Batu ED, et al. Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: a multicenter study. Joint Bone Spine 2023; 90(4): 105559. https://doi.org/10.1016/j.jbspin.2023.105559
- Pawlak-Buś K, Schmidt W, Leszczyński P. Neuropsychiatric manifestations and their attribution to systemic lupus erythematosus: a retrospective single-center study in a Polish population. Pol Arch Intern Med 2022; 132(11): 16319. https://doi.org/10.20452/pamw.16319
- Abdel-Hafez MA, Abdel-Nabi H. Juvenile systemic lupus erythematosus: onset patterns and short-term outcome in Egyptian children, a single-center experience. Lupus 2015; 24(13): 1455-61. https://doi.org/10.1177/0961203315598016
- Appenzeller S, Pereira DR, Julio PR, Reis F, Rittner L, Marini R. Neuropsychiatric manifestations in childhood-onset systemic lupus erythematosus. Lancet Child Adolesc Health 2022; 6(8): 571-81. https://doi.org/10.1016/S2352-4642(22)00157-2
- Giani T, Smith EM, Al-Abadi E, et al. Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: data from the UK Juvenile-onset systemic lupus erythematosus cohort study. Lupus 2021; 30(12): 1955-65. https://doi.org/10.1177/09612033211045050
- Hanly JG. Diagnosis and management of neuropsychiatric SLE. Nat Rev Rheumatol 2014; 10: 338-47. https://doi.org/10.1038/nrrheum.2014.15
- Valdez-López M, Aguirre-Aguilar E, Valdés-Ferrer SI, et al. Posterior reversible encephalopathy syndrome: a neuropsychiatric manifestation of systemic lupus erythematosus. Autoimmun Rev 2021; 20(2): 102739. https://doi.org/10.1016/j.autrev.2020.102739
- Kwan A, Marzouk S, Ghanean H, et al. Assessment of the psychometric properties of patient-reported outcomes of depression and anxiety in systemic lupus erythematosus. Semin Arthritis Rheum 2019; 49(2): 260-6. https://doi.org/10.1016/j.semarthrit.2019.03.004
- Tayer-Shifman OE, Bingham KS, Touma Z. Neuropsychiatric systemic lupus erythematosus in older adults: diagnosis and management. Drugs Aging 2022; 39: 129-42. https://doi.org/10.1007/s40266-021-00911-0
- Fujieda Y. Diversity of neuropsychiatric manifestations in systemic lupus erythematosus. Immunol Med 2020; 43(4): 135-41. https://doi.org/10.1080/25785826.2020.1770947
- Gupta R, Agapoff M, Diamond B. Neuropsychiatric systemic lupus erythematosus-current and novel treatments. Curr Opin Rheumatol 2026; 38(2): 115-20. https://doi.org/10.1097/BOR.0000000000001141
- Vilaiyuk S, Sirachainan N, Wanitkun S, Pirojsakul K, Vaewpanich J. Recurrent macrophage activation syndrome as the primary manifestation in systemic lupus erythematosus and the benefit of serial ferritin measurements: a case-based review. Clin Rheumatol 2013; 32: 899-904. https://doi.org/10.1007/s10067-013-2227-1
- Wafa A, Hicham H, Naoufal R, et al. Clinical spectrum and therapeutic management of systemic lupus erythematosus-associated macrophage activation syndrome: a study of 20 Moroccan adult patients. Clin Rheumatol 2022; 41: 2021-33. https://doi.org/10.1007/s10067-022-06055-9
- Sammaritano LR, Askanase A, Bermas BL, et al. 2025 American College of Rheumatology guideline for the treatment of systemic lupus erythematosus. Arthritis Rheumatol 2026:78(7): 1361-86. https://doi.org/10.1002/art.43452
- Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019; 78(6): 736-45. https://doi.org/10.1136/annrheumdis-2019-215089
- Bertsias GK, Ioannidis JP, Aringer M, et al. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis 2010; 69(12): 2074-82. https://doi.org/10.1136/ard.2010.130476.
- Lim SC, Md-Yusof YL, Johari B, Abdul-Kadir RF, Tang SP. Neuropsychiatric lupus in Malaysian children: clinical characteristics, imaging features and 12-month outcomes. Turk J Pediatr 2021; 63(5): 743-51. https://doi.org/10.24953/turkjped.2021.05.002
Telif hakkı ve lisans
Telif hakkı © 2026 Yazar(lar). Açık erişimli bu makale, orijinal çalışmaya uygun şekilde atıfta bulunulması koşuluyla, herhangi bir ortamda veya formatta sınırsız kullanım, dağıtım ve çoğaltmaya izin veren Creative Commons Atıf Lisansı (CC BY) altında dağıtılmıştır.