Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2000 Feb;59(2):120-4.
doi: 10.1136/ard.59.2.120.

Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature

B Kovacs  1 , T L Lafferty, L H Brent, R J DeHoratius
Affiliations
Review

Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature

B Kovacs et al. Ann Rheum Dis. 2000 Feb.

Abstract

Objective: To give a comprehensive review of transverse myelopathy (TM), a rare but serious condition reported in 1-2% of patients with systemic lupus erythematosus (SLE).

Methods: 14 patients with SLE and TM were evaluated and 91 additional cases published in the English and German literature reviewed.

Results: TM presented either as the initial manifestation or within five years of the diagnosis of SLE. Most patients presented with a detectable sensory deficit at the thoracic level. In our 14 patients, 22% of the patients showed complete neurological recovery, whereas in the total patient population of 105 (our cases plus those reviewed in the literature), complete recovery was observed in 50%, partial recovery in 29% and no improvement or deterioration in 21%. Treatment with intravenous methylprednisolone followed by cyclophosphamide seemed to be most effective. Seventy per cent of the total patient population had abnormal magnetic resonance imaging findings. In our group of 14 patients, those with higher disease activity (measured by the SLAM) at onset of TM were treated more aggressively (for example, with plasmapheresis and intravenous pulse cyclophosphamide). TM in our patients was associated with antiphospholipid antibodies in 43% of the cases as compared with 64% of the total patient population. Optic neuritis occurred in 48% of the total patient population with SLE and TM, suggesting an association.

Conclusions: TM in SLE is a poorly understood entity. Outcome might be more favourable than previously suggested. There is an association of TM with antiphospholipid antibodies in SLE patients. Treatment including intravenous cyclophosphamide may improve the final outcome. This report emphasises the need for multicentre trials to establish guidelines for optimal treatment.

PubMed Disclaimer

Figures

Figure 1
Figure 1
MRI from one of our patients (patient 2) showing increased signal intensity of the mid to lower thoracic spinal cord and atrophy (attenuation) of the spinal cord.
Figure 2
Figure 2
MRI results compared with outcome. Data from patients with an abnormal MRI (n=39) are shown in black columns, those of patients with a normal MRI (n=16) in gray columns.
See this image and copyright information in PMC

References

    1. J Neurol. 1992 Feb;239(2):61-4 - PubMed
    1. Ulster Med J. 1996 May;65(1):91-4 - PubMed
    1. J Rheumatol. 1992 May;19(5):829-30 - PubMed
    1. Br J Rheumatol. 1992 Aug;31(8):555-8 - PubMed
    1. Am J Phys Med Rehabil. 1993 Jun;72(3):158-61 - PubMed

Publication types