Session Type: Abstract Submissions (ACR)
Background/Purpose Imaging findings in systemic lupus erythematosus (SLE) patients are diverse; and diffuse or regional atrophy and white matter hyperintensities (WMH) have been described in variable frequency. Studies have shown that the subunit of high molecular weight neurofilament (NF-H) is more resistant to degradation and therefore can be found in large quantities in the serum of patients with CNS injury. However the prevalence and clinical significance of WMH and it´s association with serum NF-H levels in childhood-onset SLE (cSLE) is still unknown. We aimed to determine if serum NF-H protein levels are associated with WMH in cSLE patients.
Methods We included consecutive cSLE patients (disease-onsebefore the age of 18)followed in a cohort at the Pediatric Rheumatology Unit at the StateUniversity of Campinas. The control group was consisted by age and sex matched healthy individuals.A complete clinical, laboratory and neurological evaluation was performed in all subjects. Neurological manifestations were analyzed according to the ACR classification criteria. MRI scans were obtained through a standardized protocol (3Tessla Philips). WMH were analyzed in T2-weighted images using a semiautomated computer program developed in our laboratory (Neuroline) and validated against standard MRI segmentation programs. Disease activity was measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and cumulative SLE-related damage was determined using the Systemic Lupus International Collaborating Clinics (SLICC)/ACR Damage Index (SDI) at time of blood withdrawal. NF-H protein levels were measured by enzyme-linked immunosorbent assay using commercial kits from BioVendor, Inc (Czech Republic). Data were compared by non-parametric tests.
Results We included 70 consecutivecSLE patients [63(90%) female; median age=16 years (range 9-30)]. The median disease duration was 3 years (range 0-13 years). At time of study entry, 30 (42.5%) cSLE patients had active disease (SLEDAI ≥3) and 28 (40%) had a history of neuropsychiatric (NP) manifestations. Eighteen (25.7%) cSLE had cumulative damage [SDI scores≥1 (range 1-3].The white matter lesions were identified in 63 (90%) patients. WMH lesions occurred more frequently in the subcortical WM. The median NF-H protein levels were significantly increased in cSLE(55.1 pg/mL; range 1.00-330.3) when compared to controls (60.68pg/mL; range 16.1-76.7; p<0.001).
The vast majority of cSLE patients presented WMH using an objective quantitative MRI method. The presence of WMH was associated withhigher NF-Hprotein levels, suggesting that these lesions are a result of CNS injuryand should be followed carefully.
A. T. Lapa,
N. A. Sinicato,
L. Ferreti Silveira,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/neurofilament-h-is-associated-with-white-matter-lesions-in-childhood-onset-systemic-lupus-erythematosus/