New insights into central nervous system lupus: a clinical perspective

Patients with systemic lupus erythematosus (SLE) experience a wide array of neurologic (N) and psychiatric (P) events, some of which are directly attributable to lupus. Regardless of attribution, NP events have a significant impact on individual patient's health-related quality of life. Primary immunopathogenic mechanisms of NP-SLE include vasculopathy, autoantibody production, and intrathecal inflammatory mediators. The recently described anti-NR2 glutamate receptor antibodies have been implicated in animal models of neuronal injury, but their role in the pathogenesis of human NP-SLE is unclear. The diagnosis of NP-SLE remains largely one of exclusion, although the detection of select autoantibodies, CSF analysis, and appropriate use of neuroimaging and neuropsychometric testing may provide support in the evaluation of individual patients. Therapeutic options include symptomatic therapies, immunosuppression, and anticoagulation.