Dr. Parrish has received consulting fees, speaking fees, and/or honoraria from Siemens Medical Systems, Australia (less than $10,000).
Brain Morphometric Changes Associated With Childhood-Onset Systemic Lupus Erythematosus and Neurocognitive Deficit
Article first published online: 26 JUL 2013
© 2013 The Authors. Arthritis & Rheumatism is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Arthritis & Rheumatism
Volume 65, Issue 8, pages 2190–2200, August 2013
How to Cite
Gitelman, D. R., Klein-Gitelman, M. S., Ying, J., Sagcal-Gironella, A. C. P., Zelko, F., Beebe, D. W., DiFrancesco, M., Parrish, T., Hummel, J., Beckwith, T. and Brunner, H. I. (2013), Brain Morphometric Changes Associated With Childhood-Onset Systemic Lupus Erythematosus and Neurocognitive Deficit. Arthritis & Rheumatism, 65: 2190–2200. doi: 10.1002/art.38009
The contents herein are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
- Issue published online: 26 JUL 2013
- Article first published online: 26 JUL 2013
- Accepted manuscript online: 10 MAY 2013 02:13PM EST
- Manuscript Accepted: 2 MAY 2013
- Manuscript Received: 30 OCT 2012
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases Clinical Research Center). Grant Number: P60-AR-047884
- National Center for Research Resources Institutional Clinical and Translational Science Award program. Grant Number: 5 UL1-RR-026314-03
To use structural magnetic resonance imaging (MRI) to characterize changes in gray matter and white matter volumes between patients with childhood-onset systemic lupus erythematosus (SLE) and matched controls, between patients with childhood-onset SLE with and those without neurocognitive deficit, and in relation to disease duration and treatment with steroids.
Twenty-two patients with childhood-onset SLE and 19 healthy controls underwent high-resolution structural MRI. Probability density maps for gray matter and white matter were compared between groups.
Neuropsychological testing confirmed the presence of neurocognitive deficit in 8 patients with childhood-onset SLE. Multiple brain regions had reduced gray matter volume in the patients with childhood- onset SLE with neurocognitive deficit versus controls or patients with childhood-onset SLE without neurocognitive deficit. Neither disease duration nor cumulative oral or intravenous steroid doses accounted for decreases in gray matter. White matter volume was also reduced in patients with childhood-onset SLE with neurocognitive deficit, and the reduction was positively associated with both disease duration and cumulative oral steroid dose. Conversely, higher cumulative intravenous steroid doses were associated with higher white matter volumes.
Neurocognitive deficit in patients with childhood-onset SLE is associated with multifocal decreases in both gray and white matter volumes. Since only white matter volume changes are related to disease duration and cumulative oral steroid use, this may suggest that gray and white matter alterations relate to different underlying mechanisms. Further work is needed to understand the relationship between gray and white matter alterations in childhood-onset SLE, whether the underlying mechanisms relate to immunologic, vascular, or other causes, and whether the changes are reversible or preventable. Likewise, the protective properties of intravenous steroids in maintaining white matter volumes require confirmation in larger cohorts.