Background/Purpose Neuropsychiatric manifestations occur in 12-95% of SLE patients. Recent studies have demonstrated the high specificity of antiribosomal P antibodies for SLE. Antiribosomal P antibodies are able to bind to neuronal cells in areas of the limbic system which are responsible to the olfactory. We aimed to analyze the prevalence of olfactory disorder in SLE, correlate olfactory with presence of neuropsychiatric manifestations, disease activity and the presence of antiribosomal P antibodies.

Methods Consecutive SLE patients followed at the rheumatology unit of the State University of Campinas were enrolled in this study. 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. Mood and anxiety disorders were determined through Becks Depression and Becks Anxiety Inventory. SLE patients were further assessed for clinical and laboratory SLE manifestations, disease activity [SLE Disease Activity Index (SLEDAI)], damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). Anti-ribosomal P antibody was performed by Enzyme Linked Immuno Sorbent Assay. Olfactory functions were evaluated using the Sniffin’ Sticks test, in 3 stages: threshold, discrimination, and identification of different odors (TDI).

Results We included 120 SLE patients (93.3% female; mean age 40.3 years; SD±11.3 years) and 135 healthy volunteers (91.1% female; mean age 37.6 years; SD±12.4 years). Anxiety was observed in 81(67.5%) SLE patients and in 49 (39.2%) controls (p<0.001). Depression was identified in 56 (46.6%) SLE patients and in 39 (28.8%) controls (p=0.004). Anti-ribosomal P antibodies were identified exclusively in SLE patients and were present in 13 (10.8%) of them (p<0.001). Olfactory changes were observed in 62 (51.6%) SLE patients and in 40 (29.6%) controls (p=0.001). SLE patients had significantly lower mean in all phases of the olfactory assessment. The olfactory was also inversely associated with anxiety (p=0.004, R=-0.18), depression (p=0.01, R =-0.232), cumulative damage (p=0.002, R =-0.282) and age (p<0.001, R=-0.353). The TDI was correlated with a CNS involvement, and patients with NP manifestations [mean of 28.35 (SD ± 5.30)] points, whereas patients without NP manifestations had a mean TDI of 30.8 (SD ± 4.51) points (p<0.001). Antiribosomal P antibodies were not associated with CNS involvement (p=0.730), but when we analyzed each manifestation separately, we observed an association between the presence of antiribosomal P antibodies and psychosis (p<0.046). We also observed an association between antiribosomal P antibodies and disease activity (p=0.036).

Conclusion SLE patients have a significant decrease of smell when compared to healthy controls. Olfactory changes are associated with a history of neuropsychiatric symptoms, anxiety, depression, cumulative damage, and age. Antiribosomal P antibodies were exclusively observed in SLE patients compared to healthy controls and they were associated with psychosis and disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sense-of-smell-anti-ribosomal-p-antibodies-and-neuropsychiatric-manifestations-in-systemic-lupus-erythematosus/