Natural history of longitudinally extensive transverse myelitis in 35 Hispanic patients with systemic lupus erythematosus: good short-term functional outcome and paradoxical increase in long-term mortality

Autor:	Luis Dávila-Maldonado, Joel Ceballos-Ceballos, Sergio I. Valdés-Ferrer, L Quintanilla-González, Carlos Cantú-Brito, P Guraieb-Chaín, D Aguirre-Villarreal, H Fragoso-Loyo, I Treviño-Frenk, S Morales-Moreno, Alejandra González-Duarte, H Sentíes-Madrid, F Vega-Boada, Fernando Flores-Silva, S Murra-Antón, E Díaz de León-Sánchez, Jesús Higuera-Calleja, O Longoria-Lozano
Rok vydání:	2018
Předmět:	Adult Male Pediatrics medicine.medical_specialty Neurological complication Myelitis Transverse Transverse myelitis Tertiary Care Centers Young Adult 03 medical and health sciences 0302 clinical medicine Rheumatology Azathioprine Humans Lupus Erythematosus Systemic Medicine Mexico 030203 arthritis & rheumatology business.industry medicine.disease Magnetic Resonance Imaging Term (time) Natural history Prednisone Female Long term mortality business 030217 neurology & neurosurgery
Zdroj:	Lupus. 27:1279-1286
ISSN:	1477-0962 0961-2033
DOI:	10.1177/0961203318770015
Popis:	Background and objective Acute transverse myelitis (TM) is an infrequent neurological complication of systemic lupus erythematosus (SLE). Short-term outcome varies widely between cohorts. Little is known about the epidemiology and long-term functional outcome of TM associated to SLE. Methods Patients with SLE and acute TM were identified during hospital admission, visits to the Emergency Room or the Neurology Outpatient Clinic. We evaluated ambispectively those patients with SLE presenting with clinical myelopathy and corroborated with spinal MRI. Cases were divided as partial (non-paralyzing) or complete (paralyzing). We determined long-term functional outcome as well as mortality in those patients with follow-up periods of at least five years. Results We identified 35 patients (partial, n = 15; complete, n = 20) in which complete clinical and imaging data were available (26 with follow-up ≥ 5 years). Patients with complete TM were significantly older than those with partial forms. Positive antiphospholipid antibodies were observed in 80% of patients, suggesting a possible mechanistical role. Surprisingly, functional recovery at one year was in general good; however, we observed a five-year mortality of 31% because of sepsis (in 10 cases) or pulmonary embolism (in one case). Conclusions Short-term outcome of SLE-related TM is generally good, and recurrence rate is low. However, we observed a long-term fatality rate of 31% for reasons unrelated to TM, suggesting that TM is a manifestation of severe immune dysregulation and a predictor of severity and mortality in patients with SLE.
Databáze:	OpenAIRE
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