Magnetic Resonance Imaging-Negative Lupus Myelitis: A Narrative Review

Area of Science:

• Neurology
• Immunology
• Rheumatology

Background:

• Magnetic resonance imaging (MRI)-negative lupus myelitis (MNLM) is a rare neurological complication of systemic lupus erythematosus (SLE).
• Diagnosing MNLM, especially when it is the initial manifestation of SLE, presents significant clinical challenges.
• Understanding the distinct characteristics and outcomes of MNLM based on prior SLE diagnosis is crucial for effective management.

Purpose of the Study:

• To analyze and compare demographic and clinical profiles, treatment strategies, and outcomes of MNLM patients with (Group A) and without (Group B) a prior SLE diagnosis.
• To identify factors influencing recovery and predict outcomes in MNLM.
• To provide insights into the heterogeneity of MNLM presentation and progression.

Main Methods:

• A comprehensive literature review of MNLM cases was conducted using PubMed.
• Patients were categorized into Group A (prior SLE diagnosis) and Group B (no prior SLE diagnosis).
• Demographic data, clinical presentations, treatment, and outcomes were analyzed using univariate and multivariate statistical methods (P < 0.05 considered significant).

Main Results:

• The study analyzed 41 MNLM cases, predominantly affecting females (8:1 ratio) with a mean age of 31.22 years.
• Thoracic cord involvement was most common (55%), with myelitis being the first SLE manifestation in 49% of patients.
• Group A showed significantly higher cervical cord localization (P = 0.019), while Group B had predominantly thoracic involvement (P = 0.041). Antiphospholipid syndrome (APS) antibody positivity was linked to better partial recovery (odds ratio [OR] = 3.2).

Conclusions:

• MNLM exhibits diverse clinical manifestations, often involving selective spinal cord tracts.
• Cervical cord localization is an independent predictor of complete recovery (OR = 3.2), whereas Anti Smith/Ribonucleoprotein/Ribosomal (Sm/RNP/Rib) antibodies are independent predictors of poor complete recovery (OR = 0.61).
• APS antibodies are associated with partial recovery, highlighting the importance of specific autoantibodies and lesion location in predicting MNLM outcomes.