Clinical features of transverse myelitis associated with systemic lupus erythematosus.
OBJECTIVE
This study aimed to identify the clinical characteristics and prognostic factors of systemic lupus erythematosus with transverse myelitis (SLE-TM) in a relatively large patient series.


METHODS
This retrospective study considered 45 SLE-TM individuals treated as inpatients and outpatients at Peking Union Medical College Hospital between 1993 and 2018. SLE-TM patients were compared with 180 controls, and SLE-TM patients with neuromyelitis optica spectrum disorder (NMOSD) were compared to those without NMOSD.


RESULTS
Compared to controls, the SLE-TM group frequently had a fever and had a significantly higher positive rate of anticardiolipin and lupus anticoagulant. Among the 45 patients, 22 met the NMOSD criteria. Compared to non-NMOSD patients, NMOSD patients had a lower incidence of rash (p = 0.023), serositis (p = 0.042) and renal disorder (p = 0.073); a lower prevalence of decreased complement (p = 0.083); and lower rates of positive anti-dsDNA (p = 0.074) and anti-Sm (p = 0.042). Among 22 SLE-TM patients with NMOSD, 18 underwent aquaporin 4 antibody testing, with 11 showing positive results. Out of the 45 patients, 39 were given methylprednisolone pulse treatment. After treatment, 32 patients had lower-limb muscle strength recovery (recovered group), whereas 13 had no change and persistent severe neurological deficits (non-recovered group). Compared to the recovered group, the non-recovered group were younger (p = 0.002), had a higher likelihood of having a fever (p = 0.020), initial severe myelitis (p < 0.001), long spinal segment involvement (p = 0.017) and higher C-reactive protein levels (p = 0.020). Methylprednisolone pulse given within two weeks of onset was more frequent in the recovered group than in the non-recovered group (p = 0.082).


CONCLUSIONS
Disease characteristics differed between SLE-TM patients with and without NMOSD. SLE and NMOSD tended to be co-morbidities. Initial severe neurological impairment, extensive spinal cord lesions, hyper-inflammation and delayed steroid impulse treatment could be predictors of poor outcome for SLE-TM.
['Zhang|S|S|https://orcid.org/0000-0003-4642-2105', 'Wang|Z|Z|https://orcid.org/0000-0003-4537-8739', 'Zhao|J|J|', 'Wu|D I|DI|', 'Li|J|J|', 'Wang|Q|Q|', 'Su|J|J|', 'Xu|D|D|https://orcid.org/0000-0002-6413-3043', 'Wang|Y|Y|', 'Li|M|M|', 'Zeng|X|X|']
D000328:Adult D017153:Antibodies, Anticardiolipin D051401:Aquaporin 4 D002097:C-Reactive Protein D016022:Case-Control Studies D002681:China D015897:Comorbidity D005260:Female D005938:Glucocorticoids D006801:Humans D016682:Lupus Coagulation Inhibitor D008180:Lupus Erythematosus, Systemic D008297:Male D008775:Methylprednisolone D008875:Middle Aged D009188:Myelitis, Transverse D009471:Neuromyelitis Optica D011379:Prognosis D012189:Retrospective Studies
transverse myelitis Systemic lupus erythematosus neuromyelitis optica spectrum disorder aquaporin 4 antibody