Lupus Article Questions Flashcards
Which populations are most affected by SLE?
African Americans
Hispanics
Asians
whites however are more likely to get NPSLE quicker
neuropsychiatric lupus (NPSLE) inadults
Usually 40% occurrence chance at the time of SLE diagnosis
Includes any of the following symptoms:
- total spectrum headaches
- seizures
- cerebrovascular accidents
- psychosis
- cranial neuropathy
- movement disorders
- cognitive and behavioral impairments
Pathogenic etiologies for NPSLE
Autoantibody production
Microangiopathy
Intrathecal production of proinflammatory cytokines
Premature atherosclerosis
Possible histologically changes with NPSLE
Neuronal toxicity
Atrophy of dendrites
Multi focal infarcts
Cortical atrophy
Gross infarcts
MS demyelination patterns
Microvasculopathies Associated with immune complexes and compliment (most common)
What protein found in the BBB endothelial cells are up-regulated in SLE/NPSLE?
ICAM-1 proteins
While it is known this protein increases diffusion across vasculature, allowing for infiltration of WBCs and immune system, it is theorized this affects the BBB in SLE patients, leading to NPSLE potentially.
What might be the reason why corticosteroids induce psychiatric disorders in SLE patients?
The BBB is weakened, allowing immune system cells to infiltrate easier, as well as the corticosteroid itself
What types of autoantibodies are known to be present in NPSLE/SLE manifested patients?
Antiphospholipid (aPL)
- very heavily tired to developing cognative dysfunction
ACL IgG/IgM
- correlates with neuropsychological defects
Lupus anticoagulant (LA)
NR2 glutamate receptor
- mediate apoptosis in neurons
What is the most common cause of death in patients with SLE/NPSLE?
Thrombolytic events
- strokes, MIs, PEs
What aspects of neuropsychological exams tend to be the weakest with patients with NPSLE/SLE?
Attention
Concentration
Psychomotor speed
What factors lead to increased cognitive decline in SLE patients
Persistently positive aPL levels
Prednisone use
Diabetes
High depression scores
Poor education
What is the major cause of CNS syndrome in SLE patients?
CNS infections
What are brain imaging results that can lead to SLE diagnosis?
Reduction in cerebral and corpus callosum area
Small focal lesions in the periventricular and subcortical white matter
Ventricular dilation
Diffuse white matter infarcts
Cortical atrophy
Hippocampal atrophy \
Treatment of SLE
Corticosteroids
Hydroxycholoroquine
Psychotropic meds (only adjunctive use)
Cyclophosphamide
What are broad and general neurological issues associated with NPSLE
Headache
Seizures
Cerebrovascular issues
Demyelination syndromes
Myelopathies
Movement disorders
Aseptic meningitis
Cognative dysfunctions
Mood disorders
Anxiety
Psychosis
Mono/poly neuropathy
Cranial neuropathy
Cullian-Barre syndrome
MG
Plexopathy
- note none of these are specific and patients can have a combination of any of these symptoms*
Anti-ribosomal-P antibodies affects in NPSLE
Studies suggest the increase presence of these antibodies are related to psychosis and inhibition of neuronal protein synthesis
Also may interact with neuronal surface-P antigens on the surface of hippocampal neurons -> neuronal cell death
