Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  3. Brey RL, Holliday SL, Saklad AR et al (2002) Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology 58:1214–1220

    PubMed  CAS  Google Scholar 

  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 29:1536–1542

    PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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. 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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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. Harel L, Sandborg C, Lee T, von Scheven E (2006) Neuropsychiatric manifestations in pediatric systemic lupus erythematosus and association with antiphospholipid antibodies. J Rheumatol 33:1873–1877

    PubMed  CAS  Google Scholar 

  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 25:1299–1304

    PubMed  CAS  Google Scholar 

  16. Ali US, Dalvi RB, Merchant RH, Mehta KP, Chablani AT, Badakere SS, Bhatia HM (1989) Systemic lupus erythematosus in Indian children. Indian Pediatr 26:868–873

    PubMed  CAS  Google Scholar 

  17. Hanly JG, McCurdy G, Fougere L, Douglas JA, Thompson K (2004) Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance. J Rheumatol 31:2156–2162

    PubMed  Google Scholar 

  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

    Article  Google Scholar 

  19. Benseler SM, Silverman ED (2005) Systemic lupus erythematosus. Pediatr Clin N Am 52:443–467. doi:10.1016/j.pcl.2005.01.010

    Article  Google Scholar 

  20. Ravelli A, Martini A (2005) Antiphospholipid syndrome. Pediatr Clin N Am 52:469–491. doi:10.1016/j.pcl.2005.01.001

    Article  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  23. Sanna G, Bartolaccini ML, Cuadrado MJ et al (2003) Neuropsychiatric manifestation in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies. J Rheumatol 30:985–992

    PubMed  Google Scholar 

  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 21:87–90

    PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  Google Scholar 

Download references

Conflict of interest statement

None

Author information

Authors and Affiliations

  1. The Pediatric Allergy and Immunology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Surjit Singh, Mukesh Kumar Gupta & Prahbhjot Malhi

  2. Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Jasmina Ahluwalia

  3. Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Paramjeet Singh

Authors
  1. Surjit Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mukesh Kumar Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jasmina Ahluwalia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paramjeet Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Prahbhjot Malhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Surjit Singh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, S., Gupta, M.K., Ahluwalia, J. et al. Neuropsychiatric manifestations and antiphospholipid antibodies in pediatric onset lupus: 14 years of experience from a tertiary center of North India. Rheumatol Int 29, 1455–1461 (2009). https://doi.org/10.1007/s00296-009-0887-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-009-0887-6

Keywords

Search

Navigation