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
. 2019 Dec;28(14):1656-1662.
doi: 10.1177/0961203319886103. Epub 2019 Nov 3.

Spinal cord syndromes in patients with systemic lupus erythematosus: differentiating lupus myelitis, neuromyelitis optica, and multiple sclerosis

J N Williams  1 , C B Speyer  1 , D J Kreps  1 , D J Kimbrough  2 , K Costenbader  1 , S Bhattacharyya  2
Affiliations

Spinal cord syndromes in patients with systemic lupus erythematosus: differentiating lupus myelitis, neuromyelitis optica, and multiple sclerosis

J N Williams et al. Lupus. 2019 Dec.

Abstract

Objective: Non-infectious myelitis in systemic lupus erythematosus (SLE) may be due to SLE myelitis, comorbid multiple sclerosis (MS), or neuromyelitis optica (NMO). We compared characteristics of these three conditions in SLE patients at a large academic institution.

Methods: We searched for neurologic diagnoses of SLE myelitis, NMO myelitis, and MS myelitis among 2297 patients with at least four 1997 American College of Rheumatology revised criteria for SLE between 2000 and 2015. Each subject was reviewed by a neurologist to confirm the underlying neurologic diagnosis. Demographic, clinical, laboratory, and radiographic data were extracted and compared using Fisher's exact test, analysis of variance, and Wilcoxon rank-sum test.

Results: Fifteen of the 2297 subjects with SLE (0.7%) met criteria for a spinal cord syndrome: seven had SLE myelitis, three had AQP4 seropositive NMO, and five had MS. The median SLE Disease Activity Index 2000 score at time of neurologic syndrome presentation was higher in SLE myelitis subjects (8, interquartile range (IQR) 7-16) compared with subjects with NMO (6, IQR 0-14) or MS (2, IQR 0-4), p = 0.02. Subjects with SLE myelitis were also more likely to have elevated anti-dsDNA antibodies at presentation (86%) compared with subjects with NMO (33%) or MS (0%), p = 0.03.

Conclusion: Myelitis occurs rarely among patients with SLE. Compared with subjects with SLE + NMO and subjects with SLE + MS, subjects with SLE myelitis had higher SLE disease activity at presentation.

Keywords: Systemic lupus erythematosus; anti-dsDNA antibodies; neuropsychiatric lupus.

PubMed Disclaimer

Conflict of interest statement

DECLARATION OF CONFLICTING INTERESTS

The Author(s) declare(s) that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Examples of Spinal MRI Findings in SLE Myelitis (Panels 1-3), Brain and Spinal MRI Findings in SLE + MS (Panels 4-5), and Spinal MRI Findings in SLE + NMO (Panel 6)
See this image and copyright information in PMC

References

    1. Choi J, Kim ST, Craft J. The pathogenesis of systemic lupus erythematosus – an update. Curr Opin Immunol 2012; 24: 651–657. - PMC - PubMed
    1. Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis Rheum 2008; 58: 15–25. - PubMed
    1. Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of Systemic Lupus International Collaborating Clinics Classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64: 2677–2686. - PMC - PubMed
    1. West SG. Neuropsychiatric lupus. Rheum Dis Clin North Am 1994; 20: 129–158. - PubMed
    1. Schulz SW, Shenin M, Mehta A, Kebede A, Fluerant M, Derk CT. Initial presentation of acute transverse myelitis in systemic lupus erythematosus: demographics, diagnosis, management and comparison to idiopathic cases. Rheumatol Int 2012; 32: 2623–2627. - PubMed