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Abstract Number: 299

Reduction of Cerebral and Corpus Callosum Volumes in Childhood-Onset Systemic Lupus Erythematosus. A Volumetric Magnetic Resonance Imaging Analysis

Aline T. Lapa1, Wesley G. Ferreira1, Mariana Postal1, Nailu A. Sinicato1, Roberto Marini2, Fernando Cendes3 and Simone Appenzeller4, 1Medicine, State University of Campinas, Campinas, Brazil, 2State University of Campinas, Campinas, Brazil, 3Neurology, State University of Campinas, Campinas, Brazil, 4Medicine, Faculty of Medical Science, State University of Campinas Unicamp, São Paulo, Brazil

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Magnetic resonance imaging (MRI), neuropsychiatric disorders and systemic lupus erythematosus (SLE)

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Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Pediatric Systemic Lupus Erythematosus, Pediatric Vasculitis and Pediatric Myositis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Cerebral atrophy has been described to occur in SLE with variable frequency. Aging, systemic diseases, corticosteroid use and central nervous system (CNS) involvement may lead to cerebral atrophy. However, studies evaluating the prevalence of cerebral atrophy in childhood-onset systemic lupus erythematosus (cSLE) using  magnetic resonance imaging (MRI) volumetric measurements are rare. Objectives: To determine the frequency of cerebral and corpus callosum atrophy in cSLE and to determine the possible relationships between atrophy and clinical, laboratory and treatment features of the disease. 

Methods: A total of 51cSLE patients (48 female; mean age=17.0; SD=3.9) and 50 healthy age and sex matched volunteers (37 women; mean age=18.4; SD=5.7) followed at the pediatric rheumatology unit of the State University of Campinas were enrolled in this study. A complete clinical, laboratory and neurological evaluation was performed in all subjects. Neurological manifestations were analyzed according to the ACR classification criteria. 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. Mood disorders were determined through Becks Depression and Becks Anxiety Inventory in all participants. SLE patients were further assessed for clinical and laboratory SLE manifestations, disease activity (SLEDAI), damage  (SDI) and current drug exposures. Total dose of corticosteroids and other immunosuppressant medications used since the onset of disease were calculated. MRI scans were performed in a 3T Phillips®scanner using a standardized protocol. Sagittal T1 weighted images were used for semiautomatic volumetric measurements. Volumes smaller 2 standard deviation from the means of controls were considered abnormal. Non-parametric tests and correlation were used for statistical analysis.

Results:

In cSLE, cerebral (mean volume=1077.1 cm3; SD=94.5) and corpus callosum  (mean volume=11.8 cm3; SD=1.8) volumes were significantly smaller when compared to cerebral (mean volume=1191.7; SD=122.1; p<0.001) and corpus callosum (mean volumes=10.8; SD=1.6; p<0.005) volumes of  healthy volunteers. Corpus callosum atrophy were identified in 4 (7.8%; p=0.005) and cerebral atrophy 7 (14%; p=0.003) cSLE and in none of the controls. The presence of corpus callosum atrophy was associated with positive anti-dsDNA antibodies (p=0.018). An indirect correlation between age and corpus callosum volume (r=-0.88; p<0.001) was observed. The presence of cerebral atrophy was associated with the presence of depression (p=0.007), vasculitis (p<0.001) and disease activity (p=0.04). No relationships between cerebral and corpus callosum volume and disease duration, the presence of CNS manifestations, total corticosteroid dose, and the presence of antiphospholipid antibodies were observed. 

Conclusion:

Cerebral and corpus callosum atrophy is observed more frequently in cSLE when compared to controls. The presence of immunological and clinical features are associated with the presence of atrophy. Depression was the only neuropsiquiatric manifestation associated with cerebral atrophy.


Disclosure:

A. T. Lapa,
None;

W. G. Ferreira,
None;

M. Postal,
None;

N. A. Sinicato,
None;

R. Marini,
None;

F. Cendes,
None;

S. Appenzeller,

FAPESP and CNPq,

2.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reduction-of-cerebral-and-corpus-callosum-volumes-in-childhood-onset-systemic-lupus-erythematosus-a-volumetric-magnetic-resonance-imaging-analysis/

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