Risk factors for neuropsychiatric manifestations in children with systemic lupus erythematosus: case-control study.
Yenny Carolina Zuniga Zambrano, Juan David Guevara Ramos, Nathalia Elena Penagos Vargas, Diana Carol Benitez Ramirez, Sandra Milena Ramirez Rodriguez, Adriana Carolina Vargas Niño, Alvaro Hernando Izquierdo Bello
Author Information
Yenny Carolina Zuniga Zambrano: Pediatric Neurology Program, Department of Pediatrics, National University of Colombia, Colombia. Electronic address: yczunigaz@unal.edu.co.
Juan David Guevara Ramos: Division of Child Neurology, "Hospital de la Misericordia" Foundation, Colombia.
Nathalia Elena Penagos Vargas: Pediatric Neurology Program, Department of Pediatrics, National University of Colombia, Colombia.
Diana Carol Benitez Ramirez: Pediatric Neurology Program, Department of Pediatrics, National University of Colombia, Colombia.
Sandra Milena Ramirez Rodriguez: Pediatric Neurology Program, Department of Pediatrics, National University of Colombia, Colombia.
Adriana Carolina Vargas Niño: Pediatric Neurology Program, Department of Pediatrics, National University of Colombia, Colombia.
Alvaro Hernando Izquierdo Bello: Pediatric Neurology program, Department of Pediatrics, National University of Colombia, "Hospital de la Misericordia" Foundation, Colombia.
BACKGROUND: Neuropsychiatric symptoms in children with systemic lupus erythematosus cause high morbidity and disability. This study analyzed risk factors associated with neuropsychiatric presentation in patients with systemic lupus erythematosus aged <18 years. METHODS: A case-control study was performed. Medical record information of patients with a diagnosis of systemic lupus erythematosus who were hospitalized with or without neuropsychiatric symptoms was collected between March 2007 and January 2012. Clinical variables, laboratory examinations, neuroimages, and disease activity (Systemic Erythematosus Lupus Disease Activity Index) and damage (Systemic Lupus International Collaborating Clinics) indices were analyzed. RESULTS: A total of 90 patients were selected, 30 with neuropsychiatric symptoms. The patients' average age was 12.2 years. The most common neuropsychiatric symptoms were seizures, migraine, and depression. The average Systemic Erythematosus Lupus Disease Activity Index was 19.86 (S.D. 10.83) and the average Systemic Lupus International Collaborating Clinics index was 2.02 (S.D. 2.43), with higher values in patients with neuropsychiatric symptoms (P = 0.001). The levels of complement C3 and C4 were significantly higher in patients with a neuropsychiatric disorder (P = 0.003). Lupus anticoagulant was found in 51.5% of patients with neuropsychiatric symptoms (odds ratio, 3.7; 95% confidence interval, 1.3-10.0). Immunosuppression with azathioprine, rituximab, or cyclophosphamide delayed the time to neuropsychiatric systemic lupus erythematosus development by 18.5 months (95% confidence interval, 10.6-26.5) compared to patients who did not receive these agents. CONCLUSIONS: The presence of lupus anticoagulant was a risk factor in our patients. The use of immunosuppressants, such as cyclophosphamide, rituximab, and azathioprine, delayed the presentation of neuropsychiatric manifestations of lupus.
