1. Transverse Myelitis in Systemic Lupus Erythematosus: Clinical Features and Prognostic Factors in a Large Cohort of Latin American Patients.
- Author
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Chiganer EH, Lessa CF, Di Pace JL, Perassolo MB, Carnero Contentti E, Alessandro L, Correale J, Farfan MF, Galiana GL, Sánchez Benavides M, Pacello F, Stagno M, Cardozo A, Nacimiento Cantero MB, Elizaur López JG, Delgadillo PD, Melgarejo P, Acosta Colman I, Vázquez Báez MA, Correa Díaz EP, Jácome Sánchez EC, Alva Linares M, Zamora Tehozol EA, Fragoso-Loyo HE, Quintanilla-González L, Batún-Garrido JAJ, Sato EI, do Reis-Neto ET, Carreño Nigro MA, and Hryb JP
- Subjects
- Adult, Female, Humans, Latin America, Neoplasm Recurrence, Local, Prognosis, Young Adult, Lupus Erythematosus, Systemic complications, Lupus Erythematosus, Systemic diagnosis, Lupus Erythematosus, Systemic drug therapy, Myelitis, Transverse diagnosis, Myelitis, Transverse drug therapy, Myelitis, Transverse epidemiology
- Abstract
Background: Acute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM., Methods: In this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS)., Results: Among patients included, 95% (n = 57) were female, and the average age was 31.6 ± 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS ≥ 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS ≥ 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse., Conclusions: Systemic lupus erythematosus-related ATM may occur at any time of SLE course, leading to significant disability despite treatment. Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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