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Neuropsychiatric lupus erythematosus: future directions and challenges; a systematic review and survey
Zhang, Yongwen; Han, Huanhuan; Chu, Lanfang.
  • Zhang, Yongwen; Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine. Department of Endocrinology and Rheumatology. CN
  • Han, Huanhuan; Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine. Department of Endocrinology and Rheumatology. CN
  • Chu, Lanfang; General Hospital of Eastern Military Area. Department of Integrated Traditional Chinese and Western Medicine. CN
Clinics ; 75: e1515, 2020. tab, graf
Article in English | LILACS | ID: biblio-1101095
ABSTRACT
This study aimed to systematically review neuropsychiatric lupus erythematosus (NPSLE) and establish a simplified diagnostic criterion for NPSLE. Publications from 1994 to 2018 in the database (Wanfang data (http//www.wanfangdata.com.cn/index.html) and China National Knowledge Internet (http//www.cnki.net)) were included. In total, 284 original case reports and 24 unpublished cases were collected, and clinical parameters were analyzed. An attempt was made to develop a set of simplified diagnostic criteria for NPSLE based on cases described in the survey and literature; moreover, and pathophysiology and management guidelines were studied. The incidence rate of NPSLE was estimated to be 12.4% of SLE patients in China. A total of 408 NPSLE patients had 652 NP events, of which 91.2% affected the central nervous system and 8.8% affected the peripheral nervous system. Five signs (manifestations, disease activity, antibodies, thrombosis, and skin lesions) showed that negative and positive predictive values were more than 70%, included in the diagnostic criteria. The specificity, accuracy, and positive predictive value (PPV) of the revised diagnostic criteria were significantly higher than those of the American College of Rheumatology (ACR) criteria (χ2=13.642, 15.591, 65.010, p<0.001). The area under the curve (AUC) for revised diagnostic criteria was 0.962 (standard error=0.015, 95% confidence intervals [CI] =0.933-0.990), while the AUC for the ACR criteria was 0.900 (standard error=0.024, 95% CI=0.853-0.946). The AUC for the revised diagnostic criteria was different from that for the ACR criteria (Z=2.19, p<0.05). Understanding the pathophysiologic mechanisms leading to NPSLE is essential for the evaluation and design of effective interventions. The set of diagnostic criteria proposed here represents a simplified, reliable, and cost-effective approach used to diagnose NPSLE. The revised diagnostic criteria may improve the accuracy rate for diagnosing NPSLE compared to the ACR criteria.
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Full text: Available Index: LILACS (Americas) Main subject: Lupus Vasculitis, Central Nervous System / Lupus Erythematosus, Systemic Type of study: Practice guideline / Prognostic study / Qualitative research / Systematic reviews Limits: Humans Country/Region as subject: Asia Language: English Journal: Clinics Journal subject: Medicine Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: General Hospital of Eastern Military Area/CN / Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine/CN

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Full text: Available Index: LILACS (Americas) Main subject: Lupus Vasculitis, Central Nervous System / Lupus Erythematosus, Systemic Type of study: Practice guideline / Prognostic study / Qualitative research / Systematic reviews Limits: Humans Country/Region as subject: Asia Language: English Journal: Clinics Journal subject: Medicine Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: General Hospital of Eastern Military Area/CN / Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine/CN