Background/Purpose: Neurocognitive dysfunction (NCD) is one of the most commonly reported neuropsychiatric symptoms in patients with juvenile systemic lupus erythematosus (SLE), even without overt CNS disease. Signs of NCD are often subtle and difficult to ascertain in daily clinical practice, requiring formal neuropsychological testing (NPT). Ischemic and inflammatory mechanisms are key components of its immunopathogenesis, including abnormalities of the blood–brain barrier and autoantibody-mediated production of proinflammatory cytokines. Several studies have identified a possible role of autoantibody activity, cerebral ischemia, disease duration, disease activity, therapeutics, pro-inflammatory cytokines and behavioural factors. Some studies have suggested that through the use of serum inflammatory markers such as C-reactive protein (CRP), it is possible to predict small vessel vasculopathy. The aim is to assess the association between serum inflammatory markers and cognitive dysfunction in juvenile-onset SLE (jSLE) patients.

Methods: A cross-sectional sample of jSLE patients, currently aged ≥ 16 years, completed a psychosocial assessment including the SF-36, HADS, SHS, BriefCope and MMSE questionnaires, between October 2018- May 2019. Local Ethics Committee approved the study. All patients fulfilled both 2012 and 2019 EULAR/ACR classification criteria for SLE. Juvenile-onset was defined as age at diagnosis < 18 years. Demographics and clinical characteristics were collected. Statistical analysis was performed with SPSS®. Variables were compared with spearman correlations tests.

Results: 30 jSLE patients were included in the study, 90%female, with median (min-max) age of 21 (16-35) years, with mean (SD) age at diagnosis of 15.8 ± 2.1 years. Median CRP and ESR serum levels were 1.9 (0.1-9.6) mg/L and 19 (2-75) mm/H, respectively. Mean (SD) platelets counts, leucocytes counts and haemoglobin levels were 248×10⁹/L (12.5 x10⁹/L), 6.2 x10⁹/L  (0.4 x x10⁹/L) and 13.2 (0.3) g/dL, respectively. Mean values (SD) of psychosocial assessment were: MMSE of 27.7 (1.8); HADS – Depression 3.9 (3.3), HADS – Anxiety 9 (4.3), SHS 5.2 (1.02); Physical health SF-36 of 66.8 (9.9) and Mental health SF-36 of 68.9 (17.5). 23.3% showed mild cognitive impairment, 63.3% anxiety and 13.3% depression. We observed significant inverse correlations between both serum CRP levels and platelets counts and MMSE scores (p=0.044, ρ=-0.377; p=0.044; ρ=-0.377, respectively).

Conclusion: Our findings suggest that higher CRP serum levels and platelets counts were associated with lower MMSE scores, meaning more NCD in these patients. Identification of high-risk subgroups for NPS involvement could lead to earlier diagnosis with NPT and targeted interventions, thus improving their prognosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-inflammation-and-cognitive-dysfunction-in-jsle-patients/