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Rheumatology International

, Volume 29, Issue 12, pp 1455–1461 | Cite as

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

  • Surjit SinghEmail author
  • Mukesh Kumar Gupta
  • Jasmina Ahluwalia
  • Paramjeet Singh
  • Prahbhjot Malhi
Original Article

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.

Keywords

Neuropsychiatric lupus Pediatric lupus Antiphospholipid antibodies Anticardiolipin antibodies Childhood SLE India 

Notes

Conflict of interest statement

None

References

  1. 1.
    Tan EM, Cohen AS, Fries JF et al (1982) 1982 Revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277. doi: 10.1002/art.1780251101 PubMedCrossRefGoogle Scholar
  2. 2.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725–1726. doi: 10.1002/art.1780400928 PubMedCrossRefGoogle Scholar
  3. 3.
    Brey RL, Holliday SL, Saklad AR et al (2002) Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology 58:1214–1220PubMedGoogle Scholar
  4. 4.
    Sibbitt WL Jr, Brandt JR, Johnson CR et al (2002) The incidence and prevalence of neuropsychiatric syndromes in pediatric onset lupus systemic lupus erythematosus. J Rheumatol 29:1536–1542PubMedGoogle Scholar
  5. 5.
    Yancey CL, Doughty RA, Athreya BH (1981) Central nervous system involvement in childhood systemic lupus erythematosus. Arthritis Rheum 24:1389–1395. doi: 10.1002/art.1780241109 PubMedCrossRefGoogle Scholar
  6. 6.
    Steinlin MI, Blaser SI, Gilday DL et al (1995) Neurologic manifestations of pediatric systemic lupus erythematosus. Pediatr Neurol 13:191–197. doi: 10.1016/0887-8994(95)00110-2 PubMedCrossRefGoogle Scholar
  7. 7.
    Parikh S, Swaiman KF, Kim Y (1995) Neurologic characteristics of childhood lupus erythematosus. Pediatr Neurol 13:198–201. doi: 10.1016/0887-8994(95)00186-J PubMedCrossRefGoogle Scholar
  8. 8.
    Haji Muhammad Ismail Hussain I, Loh WF, Sofiah A (1999) Childhood cerebral lupus in an Oriental population. Brain Dev 21:229–235. doi: 10.1016/S0387-7604(99)00012-1 PubMedCrossRefGoogle Scholar
  9. 9.
    Olfat MO, Al-Mayouf SM, Mujaffer MA (2004) Patterns of neuropsychiatric manifestations and outcome in juvenile systemic lupus erythematosus. Clin Rheumatol 23:395–399. doi: 10.1007/s10067-004-0898-3 PubMedCrossRefGoogle Scholar
  10. 10.
    (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42:599–608. doi: 10.1002/1529-0131(199904)42:4<599::AID-ANR2>3.0.CO;2-F
  11. 11.
    Ahluwalia J, Singh S, Garewal G (2005) Antiphospholipid antibodies in children with systemic lupus erythematosus: a prospective study in northern India. Rheumatol Int 25:530–535. doi: 10.1007/s00296-004-0501-x PubMedCrossRefGoogle Scholar
  12. 12.
    Gupta A, Singh S, Singh P, Ahluwalia J, Rath S, Minz RW (2003) Spastic quadriparesis: an unusual early manifestation of systemic lupus erythematosus. Scand J Rheumatol 32:189–190. doi: 10.1080/03009740310002579 PubMedCrossRefGoogle Scholar
  13. 13.
    Singh S, Devidayal, Kumar L (2002) Mortality patterns in childhood lupus—10 years’ experience in a developing country. Clin Rheumatol 21:462–465. doi: 10.1007/s100670200116
  14. 14.
    Harel L, Sandborg C, Lee T, von Scheven E (2006) Neuropsychiatric manifestations in pediatric systemic lupus erythematosus and association with antiphospholipid antibodies. J Rheumatol 33:1873–1877PubMedGoogle Scholar
  15. 15.
    Thumboo J, Fong KY, Chng HH, Koh ET, Chia HP et al (1998) The effects of ethnicity on disease patterns in 472 Orientals with systemic lupus erythematosus. J Rheumatol 25:1299–1304PubMedGoogle Scholar
  16. 16.
    Ali US, Dalvi RB, Merchant RH, Mehta KP, Chablani AT, Badakere SS, Bhatia HM (1989) Systemic lupus erythematosus in Indian children. Indian Pediatr 26:868–873PubMedGoogle Scholar
  17. 17.
    Hanly JG, McCurdy G, Fougere L, Douglas JA, Thompson K (2004) Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance. J Rheumatol 31:2156–2162PubMedGoogle Scholar
  18. 18.
    DD Mitsikostas, Sfikakis PP, Goadsby PJ (2004) A meta-analysis for headache in systemic lupus erythematosus. Brain 127:1200–1209. doi: 10.1093/brain/awh146 CrossRefGoogle Scholar
  19. 19.
    Benseler SM, Silverman ED (2005) Systemic lupus erythematosus. Pediatr Clin N Am 52:443–467. doi: 10.1016/j.pcl.2005.01.010 CrossRefGoogle Scholar
  20. 20.
    Ravelli A, Martini A (2005) Antiphospholipid syndrome. Pediatr Clin N Am 52:469–491. doi: 10.1016/j.pcl.2005.01.001 CrossRefGoogle Scholar
  21. 21.
    von Scheven E, Glidden DV, Elder ME (2002) Anti-beta2-glycoprotein I antibodies in pediatric systemic lupus erythematosus and antiphospholipid syndrome. Arthritis Rheum 47:414–420. doi: 10.1002/art.10510 CrossRefGoogle Scholar
  22. 22.
    Herranz MT, Rivier G, Khamashta MA, Blaser KU, Hughes GR (1994) Association between antiphospholipid antibodies and epilepsy in patients with systemic lupus erythematosus. Arthritis Rheum 37:568–571. doi: 10.1002/art.1780370418 PubMedCrossRefGoogle Scholar
  23. 23.
    Sanna G, Bartolaccini ML, Cuadrado MJ et al (2003) Neuropsychiatric manifestation in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies. J Rheumatol 30:985–992PubMedGoogle Scholar
  24. 24.
    Ishikawa O, Ohnishi K, Miyachi Y, Ishizaka H (1994) Cerebral lesions in systemic lupus erythematosus detected by magnetic resonance imaging. Relationship to anticardiolipin antibody. J Rheumatol 21:87–90PubMedGoogle Scholar
  25. 25.
    Wilson WA, Gharain AE, Lockshin MD, Branch DW, Piffe JC et al (1999) International consensus statement on the preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 42:1309–1311. doi: 10.1002/1529-0131(199907)42:7<1309::AID-ANR1>3.0.CO;2-F PubMedCrossRefGoogle Scholar
  26. 26.
    Miyalis S, Lockshin MD, Atsuni T, Branch DW, Brey RL, Cervera RL et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost 4:295–300. doi: 10.1111/j.1538-7836.2006.01753.x CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Surjit Singh
    • 1
    Email author
  • Mukesh Kumar Gupta
    • 1
  • Jasmina Ahluwalia
    • 2
  • Paramjeet Singh
    • 3
  • Prahbhjot Malhi
    • 1
  1. 1.The Pediatric Allergy and Immunology Unit, Department of Pediatrics, Advanced Pediatric CenterPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of HematologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of Radiodiagnosis and ImagingPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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