Background/Purpose: The prevalence of peripheral neurological manifestations in Systemic Lupus Erythematosus (SLE) ranges between 5% and 27% and are a major cause of morbidity. The aim of this study is to compare clinical characteristics and neurophysiologic patterns of peripheral neuropathies (PNP) in patients with SLE.

Methods: A retrospective study was performed. We included patients with SLE (SLICC 2012 criteria), who presented a PNP associated to SLE according to ACR 1999 nomenclature, since January 2015 to December 2017. Patients were classified according to the neurophysiologic pattern by the Neuromuscular Clinic Disorders at our Institute in 3 groups: 1. Sensory or sensory motor axonal neuropathy (ANP). 2. Mononeuropathy single or multiplex (MNP), and 3. Demyelinating neuropathy (DNP). The medical records were reviewed by an expert rheumatologist. Demographic characteristics: gender, age, Body Mass Index (BMI), and comorbidities (Diabetes Mellitus [DM] and Hypertension [HT]) were compared. Lupus characteristics: SLICC criteria, time between SLE diagnosis and PNP, ACR / 2012 criteria, disease activity (SLEDAI-2K), cumulative damage (ACR/SLICC-DI), and treatment were compared between the PNP groups. One year after the event, disease activity, cumulative damage, treatment, and a new neurophysiologic study performed, and death was reviewed. Statistical analysis: Continuous variables were compared using Mann-Whitney U, categorical variables were compared using Chi-squared test and Fisher exact test as appropriate. Kruskal-Wallis test for multiple comparisons.

Results: Forty one PNP were included, 17 (41.5%) ANP, 16 (39%) MNP, and 8 (19.5%) DNP. Patients with ANP had lower BMI than MNP and DNP (p < 0.05). Eleven patients had a comorbidity, DM in 3 (7.31%) and HT in 9 (21.9%). No difference was found between age, sex and time between SLE diagnosis and PNP. Patients with DNP presented more cutaneous manifestations (alopecia and chronic cutaneous lupus) compared with MNP (50% vs 12.5%, p < 0.046; 25% vs 0%, p < 0.037, respectively). Patients with MNP had more synovitis compared with ANP (100% vs 76.5%, p < 0.038). Disease activity was similar between the groups, the median SLEDAI 2-K was 6 (IQR 2.5-12.5). However, renal and pleuritis manifestations were more frequently present in the DNP group comparing with MNP and ANP (p < 0.05). Cumulative damage was similar between the 3 groups, the median SLICC-DI was 0 (IQR 0-1). Pulses of methylprednisolone, cyclophosphamide, and higher doses of prednisone were used in the MNP and DNP than in the ANP group (p < 0.05). One year after, 100% of patients were alive, SLEDAI-2K and SLICC-DI scores were similar between groups. DNP was more frequently revalued with a new neurophysiologic study than the other groups (p < 0.05).

Conclusion: ANP were the most frequent PNP. Patients with PNP have moderate disease activity at the time of presenting the PNP. The DNP and MNP were considered more severe and received more aggressive treatment than the ANP.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-and-neurophysiological-patterns-of-peripheral-neuropathies-in-patients-with-systemic-lupus-erythematosus-a-single-center-experience/