Phospholipid antibodies in the cerebrospinal fluid and serum, in SLE patients with suspected CNS involvement and associations with depression and cognitive impairment.

Abstract

Master thesis, Programmet in Medicine: TITLE: Phospholipid antibodies in the cerebrospinal fluid and serum, in SLE patients with suspected CNS involvement and associations with depression and cognitive impairment. AUTHOR: Sofia Linsten, 2014, department of Rheumatology and Inflammation Research, Sahlgrenska University hospital, Gothenburg, Sweden

Introduction A broad spectrum of neuropsychiatric symptoms is common among SLE patients (NPSLE) as well as patients affected by Anti-phospholipid-syndrome (APS). Indicating a connection between neuropsychiatric illness and presence of anti phospholipid antibodies (aPLs) in patient's sera. Aims Examine if it’s possible to improve diagnosis of NPSLE patients by testing cerbrospinalfluid (CSF) for cardiolipin and β2-glycoprotein1 IgG antibodies. Investigate if aPLs presence in CSF and/or serum associates with cognitive impairment and depression. Methods CSF was collected from 51 SLE patients with neuropsychiatric involvement. Patient’s serological values of phospholipid antibodies (LA, aCL, aβ2GP1) were obtained by retrospective inspection of medical records. Comprehensive screening of depression and cognitive impairment was performed. Chi square test and Fischer’s exact test was used to calculate association between aPLs positivity, depression and cognitive impairment. Results None of the patients were CSF positive for aCL or aβ2GP1. 27% were positive in serum for at least one aPLs. 59% suffered from depression. 45% suffered from cognitive impairment. Most common cognitive impairment was linguistic designation difficulties. Association between aPLs positivity and impaired linguistic designation was significant when including limit values for β2GP1 (p= 0.032). There was no association between aPLs positivity and depression or global cognitive impairment (p >0.05) Discussion and conclusions Diagnosis was not improved by testing CSF for aCL and aβ2GP1 IgG antibodies. Depression and cognitive impairment is common under diagnosed in NPSLE patients. It’s therefore important to continuously screen SLE patients for these conditions, regardless of aPLs positivity, although an association between serological aPLs presence and impaired linguistic designation is possible.