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Background: The prevalence of SLE in Malaysia was reported as 43/100,000 individuals and Chinese (57/100,000) have the highest prevalence followed by Malays (33/100,000) and Indians (14/100,000) [1,2].
The American College of Rheumatology established case definitions and categorised neuropsychiatric syndromes into two groups: central and peripheral system involvement. There were studies showed that cognitive impairment is the commonest neuropsychiatric manifestations with a prevalence of 66% [3].
Objectives: To determine the association between neuropsychiatric manifestation with different age group among SLE patients.
Methods: This was a retrospective study. The electronic medical records of all SLE patients seen in rheumatology clinic of Hospital Sultan Ismail, Malaysia from 1/1/2007 to 31/12/2021 were reviewed. SLE patients with neuropsychiatric manifestations were selected and categorised by age into children (< 12 years old), adolescents (aged 12-18 years), young adults (aged >18 to 35 years), middle-aged adults (>35 -55 years) and elderly (>55 years). The association between neuropsychiatric manifestation with different age group was analysed by using SPSS-Fisher’s exact test.
Results: There was a total of 86 patients and female were 77. The majority were Malay (49/86) followed by the Chinese (33/86), Indians (2/86) and others (2/86). Patients were categorized into children (n:6), adolescents (n:18), young adults (n:43), middle-aged adults (n:16) and elderly (n:3) with the mean age of 28.
Our study showed the onset of neuropsychiatric manifestations occurred most during young adulthood (43/86) followed by adolescents (18/86). Seizure disorders is the commonest manifestations (36/86) followed by psychosis (17/86), poly/mononeuropathy (7/86), cognitive dysfunction (7/86), myelopathy (5/86), cranial neuropathy (4/86), mood disorders (3/86), cerebrovascular disease (3/86), movement disorders (2/86), and lastly headache and myasthenia gravis, 1 patient each. 60% of the patients had onset of neuropsychiatric manifestation during first diagnosis and another 7% developed symptoms within 1 year of diagnosis. There was no association between type of neuropsychiatric manifestation with different age group (p = 0.195). Comparison of neuropsychiatric manifestations according to age group was showed in
Neuropsychiatric manifestations according to age group
| Age group (years) | Central nervous system | Peripheral nervous system |
|---|---|---|
| Children < 12 | Seizure (4), CVD (1), Cognitive dysfunction (1) | |
| Adolescents 12-18 | Seizure (9), Psychosis (5), Mood disorders (1), Cognitive dysfunction (1) | PN/MN (2) |
| Young adults >18-35 | Seizure (18), Psychosis (10), Cognitive dysfunction (4), movement disorders (2), myelopathy (4), CVD (2) | PN/MN (2) CN (1) |
| Middle-aged adults >35-55 | Seizure (4), Psychosis (2), Mood disorders (2), Cognitive dysfunction (1), Myelopathy (1), Headache (1) | PN/MN (3) CN (2) |
| Elderly >55 | Seizure (1) | MG (1), CN (1) |
CVD: Cerebrovascular disease, PN/MN: Polyneuropathy/Mononeuropathy, CN: cranial neuropathy
Conclusion: Seizure disorders is the commonest manifestations amongst SLE patients in our study group and there was no association between neuropsychiatric manifestation with the age group.
REFERENCES:
[1]S. N. Yap, M. E. Phipps, M. Manivasagar, S. Y. Tan, and J. J. Bosco, “Fc gamma receptor IIIB-NA gene frequencies in patients with systemic lupus erythematosus and healthy individuals of Malay and Chinese ethnicity,” Immunology Letters, vol. 68, no. 2-3, pp. 295–300, 1999.View at: Publisher Site | Google Scholar
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[3]Carbotte RM, Denburg SD, Denburg JA. Prevalence of cognitive impairment in systemic lupus erythematosus. J. Nerv. Ment. Dis. 1986;174:357–364. [PubMed] [Google Scholar]
Disclosure of Interests: None declared