Clinical implications of neuropsychiatric systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an auto­ immune disorder mediated by the immune­ complex and characterised by its protean clinical mani festation and multisystemic involvement (Mak 2007a). Neuropsychiatric manifestation of SLE (NPSLE) is one of the major and most damag ing presentations. It comprises a wide range of neurological syndromes affecting the central, peripheral and autonomic nervous systems, as well as psychiatric syndromes. In view of the diverse clinical manifestation of NPSLE, the American College of Rheumatology research committee devised a nomenclature which gives case defini­ tions for 19 neuropsychiatric syndromes in SLE (ACR Ad Hoc Committee on Neuro psychiatric Lupus Nomenclature 1999) (Box 1). Albeit compre hen sive, none of the syndromes described are specific to SLE and, in fact, non­SLE causes such as complications of lupus therapy, infection of the central nervous system (CNS), metabolic dys­ function and drug intoxication may contribute to them. Hence, these complications must be excluded before being ascribed to the underlying immuno­ pathogenic mechanisms (Mak 2007b). Although overt psychiatric symptoms are often clinically obvious, subtle changes such as mild cognitive impairment are often left unnoticed. This underscores the need for careful and robust clinical assessment tools which help identify these clinically important psychopathologies. In addition, how psychiatrists formally diagnose and evaluate a wide variety of lupus­related psychiatric syndromes and their impacts by using validated assessment instruments and ultimately manage these syndromes in conjunction with rheumatologists needs to be addressed. This article reviews the immunopathogenesis, clinical manifestation and therapeutic options for NPSLE, and highlights the indispensable role of psychiatrists working with rheumatologists in the collaborative management of these conditions. Clinical implications of neuropsychiatric systemic lupus erythematosus