Background/Purpose: The underlying factor for an association between the metabolic syndrome (MetS) and cognitive decline might be a subclinical inflammation. Inflammatory mechanisms are hypothesized to be involved in the pathogenesis of cognitive impairment (CI) and in the development of diabetes and atherosclerosis.We aimed to correlate MetS, cognitive function and white matter hyperintensities (WMH) lesions in childhood-onset systemic lupus erythematosus (cSLE).

Methods: We performed a cross sectional study of 63 consecutive cSLE patients followed at the Pediatric Rheumatology Unit of the State University of Campinas and 63 age and sex matched healthy controls. All individuals were assessed for anthropometric and MetS features according to International Diabetes Federation (IDF) criteria. Body mass index (BMI) was calculated and blood was collected for the measurement of glucose, lipid profile including total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG), after a standard 12-hour fasting in all subjects. cSLE patients were further assessed for clinical and laboratory manifestations, disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC)], current and cumulative drug exposures. Cognitive evaluation was performed in all participants using Wechsler Intelligence Scale for children (WISC-III) and Wechsler Intelligence Scale for adults (WAIS), according to age and validated in Portuguese. Cognitive impairment (CI) was defined when scores were ≤2 standard deviations from controls in 1 or more subtests. Magnetic resonance imaging (MRI) scans were performed in a 3T Phillips^®scanner using a standardized protocol and T2 weighted images were used for analyze. Quantification of lesion load and volume of WMH were performed by using a semiautomatic computer program (Neuroline®). Non-parametric tests were used for statistical analysis.

Results:  MetS was observed in 11 (17.4%) cSLE patients and in none of the controls (p<0.001). We observed a higher hip circumference (p=0.030), waist-to-hip ratio (p<0.001) and hypertriglyceridemia (p=0.005) in cSLE patients when compared to controls. Controls had a higher height (p=0.003) and higher levels of HDL (p=0.004). We observed an inverse correlation between height and total corticosteroid dose adjusted by weight in cSLE patients (r=-0.285;p=0.022). CI was present in 32 (50.8%) cSLE. No association between Mets and CI was observed (p=0.3). Rey complex picture on memory subtest correlated with BMI (r=-0.249; p=0.05) and TG levels (r=0.282;p=0.028) and Boston Naming Test had an inverse correlation with total cholesterol levels (r=-0.258;p=0.047). WMH were observed in 53 (82.5%) cSLE patients and in 4 (6.3%) controls. The presence of WMH lesions was associated with sera glucose levels (p=0.039).

Conclusion: MetS features such as lipid profile and glucose levels were associated with some cognitive functions and with WMH in cSLE. This findings suggest that MetS complications go beyond the cardiovascular risk factors and should be routinely screened and treated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/metabolic-syndrome-features-can-influenciate-cognitive-functions-and-brain-lesions-in-childhood-onset-systemic-lupus-erythematosus/