Immunogenetic study of neuropsychiatric and non- neuropsychiatric systemic lupus erythematosus

الملخص EN

Objective: To explore whether immunogenetic susceptibility to neuropsychiatric systemic lupus erythematosus (NP-SLE) is different from SLE without neuropsychiatric features.

We investigated HLA class II antigens to these SLE subsets.

We also evaluated the possible association of HLA antigens and lymphocytotoxic autoantibodies.

Methods: Thirty SLE patients were included in this study.

They were selected according to the criteria of the American College of Rheumatology (ACR) from Nasr City Insurance Hospital.

Sixteen patients had neuropsychiatric features classified according to workshop consensus.

Fourteen patients did not have neuropsychiatric features.

Also 30 healthy blood donors were typed for HLA class II antigen and assayed for lymphocytotoxic autoantibodies.

The following investigations were done to all patients: ESR, CBC, ANA, AdsDNA, urine analysis, HLA class II typing, lymphocytotoxic autoantibodies and MRI scanning on the brain.

Results: HLA-DR3 antigen was significantly increased in the total group of SLE patients (p=0.05).

NP-SLE patients also presented a significantly increased HLA–DR3 antigen (p = 0.03.).

HLA-DR4 antigen may have a protective specificity for the development of neuropsychiatric features of SLE patients.

HLA-DR4 antigen was overpresented in non-NPSLE patients and underpresented in NP-SLE patients.

Lymphocytotoxic autoantibody was detected in NP-SLE patients (80 out of 16) more than in non-NP-SLE patients (2 of 14) (p = 0.05).

The presence of lymphocytotoxic autoantibodies may predispose to neuropsychiatric abnormalities.

The frequency of MRI in NP-SLE patients was highly significant and there were positive data and signs in 5 of 16 patients (31.3%) and of low significance in non-NP-SLE and there was positive data and signs in 1 of 14 patients (7.1%).

All 6 patients had one or more lesions either in the cortico-medullary junction or focal lesions and the remainder in the white matter.

Conclusion: HLA-DR4 may have a protective specificity for the development of neuropsychiatric features of SLE.

HLA-DR3 antigen conferred susceptibility to SLE and in the presence of lymphocytotoxic autoantibodies may predispose to neuro-psychiatric abnormalities.

MRI helped to reach to our result.