Longitudinal evaluation of smell alteration in systemic lupus erythematosus: importance of anti-P ribosomal and atrophy of limbic system structures

Abstract

The clinical presentations of SLE ranges from mucocutaneous manifestations CNS manifestations such as seizures and psychosis. The nervous system is affected in children and adults with SLE, and its involvement is also associated with a worse prognosis and cumulative damage. CNS involvement in SLE ranges from 25-70 % depending on the diagnostic criteria used, the type of manifestations included and the method used for the evaluation. Occur at any time of the disease, may be your first sign. Neuropsychiatric manifestations in SLE can affect mortality, quality of life and level of permanent damage. Neuropsychiatric manifestations occur in 12-95 % of patients, depending on the diagnostic criteria applied and are associated with a high morbidity and mortality. The pathophysiology of NP manifestations in SLE is multifactorial and involves the production of autoantibodies, pro- inflammatory cytokines and atherosclerosis. The presence of antibodies against neurons, ribosomes, and phospholipids have been associated with CNS manifestations in SLE. In animal model demonstrated that antineuronal antibodies induce memory deficits, seizures and neuropathological changes. In SLE, has shown increased presence of autoantibodies in patients with NP manifestations. The anti - ribosomal P antibodies ( anti P) have a prevalence of 6-46 % in SLE, depending on the ethnic group, age and clinical variables analyzed ee are associated with psychosis, depression and CNS involvement. The anti -P is able to penetrate certain cells, including the central nervous system, and block protein synthesis, leading to apoptosis, particularly in regions of the limbic system (amygdala and hippocampus). These antibodies are highly specific for systemic lupus erythematosus, and may be markers for disease activity. The presence of anti - P in patients with SLE has been associated with younger age of onset, multiorgânico involvement and various other events, among them the involvement of SNC. The first report of correlation between anti - P and neuropsychiatric manifestations in SLE was described in 1987, who reported a correlation between anti -P and psychosis in patients with SLE, it evaluated the anti -P 20 with psychosis secondary to SLE, and found the anti -P in 18 of them. In the longitudinal follow-up, it was observed the activity of anti -P in two patients with psychosis and showed that levels of anti -P increased before and during the active phases of psychosis and remained unchanged for other disease manifestations. Following these findings, conflicting reports have described a possible association between anti - P and neuropsychiatric symptoms, especially psychosis in SLE. (AU)