Neuropsychiatric systemic lupus erythematosus among Nigerians

Systemic Lupus Erythematosus (SLE) and concomitant complication of Neuropsychiatric lupus (NPSLE) are rarely reported among Africans. This retrospective study has the objectives of highlighting the clinical and laboratory characteristics of SLE subjects with neuropsychiatric manifestations seen in a private practice rheumatology clinic and comparing these with studies elsewhere. Such subjects were diagnosed using the American College of Rheumatology (ACR) criteria for SLE as well as the ACR Case definition for Neuropsychiatric SLE (NPSLE). A total of thirty three subjects (51.6%) out of the sixty four diagnosed SLE had features of NPSLE. Females were more commonly affected and the mean age was 32.8 years. Most of the subjects had either one or two concomitant syndromes. Headache was the commonest presentation (66.6%) while other common presentations were seizures (42.4), psychosis (30.3%) were also seen. Dementia was the least seen. The mean erythrocyte sedimentation rate was 95.5 mm/hr. Serology tests showed high frequencies of Anti Nuclear Antibody (ANA) and Anti ds DNA. Treatment was with standard immunosuppressives, and epileptics where indicated. The outcome was generally good with 54.5% better after six months while 7 subjects (21%) were lost to follow up and three were known to have died. NPSLE is a common presentation among Nigerian SLE patients and the pattern is as seen in other reports, though the frequencies of the syndromes vary widely. Early recognition and management with immunosuppressives are required.