Neuropsychiatric Manifestations and Complications Related to Juvenile Systemic Lupus Erythematosus
Presley Gruezo-Realpe1, Joel Loor Lainez1, Jaime Ignacio Morales Cuenca1, Maria de Los Angeles Alvarez Falcon1, Danny Japon1, Ivana Garrido1, Carlos Rodriguez Alarcon1, Javier Tomalá Haz2
1Universidad Catolica Santiago de Guayaquil, 2Servicio de Reumatología Pediátrica, Hospital del niño Dr. Francisco de Icaza Bustamente
Objective:
To determine the clinical presentation and associated complications in juvenile systemic lupus erythematosus (SLE) with neurological involvement.
Background:
Juvenile SLE is a chronic autoimmune pathology that impacts several body systems and is characterized by alternating periods of remission and relapses. Neuropsychiatric involvement is present in up to 20% of pediatric patients. Clinical manifestations are an indicator of severity in the disease and the most common are increased intracranial pressure and chronic headache, due to damage occurring to central and peripheral nerves influenced by hormonal, genetic and environmental factors.
Design/Methods:
A retrospective cross-sectional study, in which medical records of patients hospitalized between 2018 - 2023, diagnosed with SLE by SLICC 2012 and American College of Rheumatology (ACR) criteria from a referral pediatric Hospital were reviewed. Statistical analyses were performed in SPSS 25
Results:
Forty-eight patients were identified in a female to male ratio (3:1), with an average age of 10.75 ± 2.78 years. Neuropsychiatric manifestations were present in 58.3% of patients, the most common were headache (27.1%), anxiety (15.6%), depression (14.6%), seizures (10.4%), confusion (4.2%) and cerebral infarction (4.2%). In the laboratory, ANA was positive in 96.4% of patients and 89.2% had hypocomplementemia. Complications, including progressive multifocal leukoencephalopathy, occurred in 47.9%. Finally, the resulting mortality was 10.7%. There was no significant association between clinical manifestations and mortality, but there was a significant association with higher hospital admissions p = 0.007.
Conclusions:
Neuropsychiatric involvement in juvenile SLE is joint and its incidence appears to be related to increased disease activity, potentially leading to severe complications such as progressive multifocal leukoencephalopathy. Despite a low mortality rate in our study, the need for further investigations is suggested for a more complete understanding of the disease in this population.