Systemic lupus erythematosus: immunopathogenesis of neurologic dysfunction

Area of Science:

• Neurology
• Immunology
• Rheumatology

Background:

• Neurologic complications of systemic lupus erythematosus (neuro-SLE) are common and diverse.
• Manifestations range from seizures and encephalopathy to peripheral nervous system and muscle abnormalities.
• High prevalence contrasts with diagnostic challenges due to varied presentations, etiologies, and lack of specific tests.

Purpose of the Study:

• To review the common and varied neurologic complications of systemic lupus erythematosus (neuro-SLE).
• To discuss the mechanisms underlying neuro-SLE, encompassing direct immune effects, vascular injury, and secondary factors.
• To highlight the potential of recent advances in understanding neuronal dysfunction and imaging for improved diagnosis and management.

Main Methods:

• Review of existing literature on neuro-SLE.
• Categorization of neuro-SLE mechanisms into direct neuronal effects, vascular injury, and secondary insults.
• Discussion of diagnostic challenges and potential of advanced imaging techniques.

Main Results:

• Neuro-SLE presents with diverse clinical manifestations affecting the central and peripheral nervous systems.
• Mechanisms of neurologic injury include direct immune attack on neurons, immune-mediated vascular damage leading to ischemia, and non-immune factors like infection and metabolic disturbances.
• Current diagnostic approaches are challenged by the heterogeneity of neuro-SLE.

Conclusions:

• Neuro-SLE is a common yet complex condition requiring a comprehensive understanding of its varied presentations and underlying mechanisms.
• Advances in neuro-immunology and functional imaging offer promise for enhancing the diagnosis and management of neuro-SLE.
• Integrated approaches considering direct immune effects, vascular pathology, and secondary factors are crucial for effective patient care.