Neuropsychiatric manifestations and antiphospholipid antibodies in pediatric onset lupus: 14 years of experience from a tertiary center of North India.

  • Singh S
  • Gupta M
  • Ahluwalia J
 et al. 
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Abstract

The objective is to study the neuropsychiatric (NP) manifestations
in pediatric onset systemic lupus erythematosus (SLE) at a tertiary
care hospital of northwestern India applying American College of
Rheumatology (ACR) case definitions in the context of occurrence
of antiphospholipid antibodies (APLA). Data of 53 children with SLE
were analyzed for NP syndromes. Tests for detection of APLA were
performed as per international standards for quality control. Twenty-seven
of the 53 (50.94%) children with lupus had at least one NP manifestation.
The male to female ratio of our cohort of pediatric lupus was 1:2.8.
However, there was significant male preponderance in patients with
NPSLE as compared to patients without NPSLE (1:1.25 vs. 1:12; P <
0.0001). Majority of children with NPSLE (15/27, 55.5%) already
had NP manifestations at the time of diagnosis and most of them (81.5%)
had experienced more than one NP symptom. Headache was the commonest
NP manifestation and was seen in 39.6% children with SLE followed
by seizure disorder (35.8%) and cognitive dysfunction (16.9%).
Tests for APLA were carried out in 37 of 53 (69.8%) patients with
SLE and in 24 of 27 (88.8%) patients with NPSLE. While anticardiolipin
antibodies were seen more frequently in children with NPSLE as compared
to those without NPSLE (57.8 vs. 23%), lupus anticoagulant was more
frequent in children without NPSLE (53.8 vs. 34.7%). However, these
differences were statistically not significant. Eleven of the 27
children with NPSLE succumbed to their illness, primarily due to
uncontrolled disease activity. Mean duration of follow-up of patients
with NPSLE who are alive was 65.4 +/- 36.9 months. NP manifestations
are common in pediatric onset lupus and contribute to significant
morbidity. As compared to previously published literature, a significantly
greater proportion of boys were affected. APLA were frequently detected
in children with NPSLE. There is paucity of literature pertaining
to NP manifestations of pediatric lupus in the context of APLA, especially
with regard to antibodies to beta-2 glycoprotein I. To the best of
our knowledge, this is the first detailed study on NP manifestations
in childhood lupus from a developing country applying ACR case definitions.

Author-supplied keywords

  • Adolescent; Adrenal Cortex Hormones
  • Anticardiolipin
  • Antiphospholipid
  • Central Nervous System
  • Systemic
  • X-Ray Computed
  • blood/complications/immunology; Lupus Vasculitis
  • blood/complications/immunology; Magnetic Resonanc
  • blood; Antibodies
  • blood; Biological Markers
  • blood; Child; Cognition Disorders
  • epidemiology; Epilepsy
  • epidemiology; Female; Follow-Up Studies; Headache
  • epidemiology; Humans; India; Lupus Erythematosus
  • therapeutic use; Antibodies

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Authors

  • Surjit Singh

  • Mukesh Kumar Gupta

  • Jasmina Ahluwalia

  • Paramjeet Singh

  • Prahbhjot Malhi

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