Meta-analysis of anti-ribosomal P antibodies in lupus psychosis

AIM: To perform a meta-analysis of the prevalence of anti-ribosomal P(aRP) antibodies in lupus psychosis, and the odds of psychosis in aR P-positive subjects.METHODS: We identified articles by searching PubM ed, PsychI nfo, and ISI, and the reference lists of identified studies.RESULTS: Twenty-four studies met the inclusion criteria. Positive aR P antibodies were found in 51%(91 of 179 total cases) of cases of lupus psychosis. There was an almost 3.5-fold increased odds of psychosis in aR Ppositive patients(OR = 3.46, 95%CI: 1.97-6.09, P < 0.001). The population attributable risk percentage was 36% for aR P antibodies.CONCLUSION: aRP antibodies are common in lupus psychosis, although the potential mechanism(s) underlying this association remain unclear. Given the overlap between the clinical presentation and risk factors for lupus psychosis and schizophrenia, further investigation of aR P antibodies in schizophrenia is warranted.

Pathogenesis of Neuropsychiatric Syndromes of Systemic Lupus Erythematosus

The pathogenesis of neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE) is multifactorial and can involve various inflammatory cytokines, autoantibodies such as anti-neuronal antibodies, anti-ribosomal P antibodies, anti-NR2 glutamate receptor binding antibodies, anti-Sm antibodies, anti-U1-RNP antibodies and anti-phospholipid antibodies, and immune complexes (IC). Disruption of the blood-brain barrier (BBB) is integral to the neuropathology of SLE. Recently the possibility has been reported that aforementioned autoantibodies in the circulation may be strongly associated with disruption of the BBB. Each of these mechanisms might contribute to the pathogenesis of focal NPSLE (for example, cerebrovascular disease, movement disorders, myelopathy, seizures and cranial neuropathy) or diffuse NPSLE (for example, acute confusional state, psychosis and cognitive dysfunction) to varying degrees. In this review we focus on how the aforementioned autoantibodies, the BBB, IC and cytokines as well as chemokines are associated with the appearance of NPSLE.