Prevalence and follow-up analysis of evolution of severe and moderate neuropsychiatric manifestations in hospitalized systemic lupus erythematosus in the rheumatology service of the Hospital General de Fortaleza

OBJETIVO: Avaliar a prevalência e a resposta terapêutica das manifestações neuropsiquiátricas (MNP) moderadas ou graves em pacientes lúpicos internados no Hospital Geral de Fortaleza (HGF). MÉTODOS: Durante dois anos, 110 pacientes de internações consecutivas com lúpus eritematoso sistêmico, segundo os critérios do Colégio Americano de Reumatologia, foram avaliados para MNP moderadas ou graves. Nestes pacientes estudou-se: causa da internação, presença de auto-anticorpos, liquor, imagens radiológicas, análise retrospectiva dos prontuários e terapêutica utilizada. RESULTADOS: A prevalência de MNP foi de 16,4% (18/110), em 17 mulheres e um homem, com idade média de 29 anos; por ocasião do internamento, 33% (6/18) dos pacientes apresentavam apenas MNP. A ocorrência da primeira MNP foi de 11% (2/18) antes do diagnóstico, 33% (6/18) por ocasião do diagnóstico e 56% (10/18) pós-diagnóstico. A mortalidade foi de 11% (2/18). As principais MNP foram: convulsões e cefaléia (50%), psicose (22%), acidente vascular cerebral (17%) e síncope e depressão maior (11%). Resposta terapêutica: 28% (5/18) pacientes responderam à corticoterapia oral, 17% (3/18) realizaram pulso de metilprednisolona e 56% (10/18) pulso de ciclofosfamida. CONCLUSÃO: A prevalência de MNP na população estudada encontra-se no limite inferior da literatura. Na ausência de estudos clínicos controlados, a abordagem destes pacientes é fundamentada em séries de casos e na experiência profissional do serviço.OBJECTIVE: Evaluate the prevalence and therapy outcome of moderate and severe neuropsychiatric manifestations (NPM) in patients with systemic lupus erythematosus admitted at the Hospital Geral de Fortaleza. METHODS: During two years, 110 patients with consecutive hospitalizations suffering from systemic lupus erythematosus, according to the American College of Rheumatology criteria, were evaluated for moderate and severe NPM. The following parameters were studied in these patients: cause of admission, presence of auto-antibodies, cerebral spinal fluid, radiological imaging, retrospective study of medical records and treatment. RESULTS: The prevalence of NPM was 16.4% (18/110), being seventeen women and one man; the mean age was 29 years; during the hospitalization term, only 33% (6/18) of the patients had an NPM. The occurrence of the first NPM was in 11% (2/18) of the cases before diagnosis, in 33% (6/18) during diagnosis and in 56% (10/18) after diagnosis. The mortality rate was 11% (2/18). The most common NPM's were: seizures and headache (50%), psychosis (22%), cerebrovascular disease (17%), syncope and major depression (11%). Treatment outcome: 28% (5/18) of the patients responded to oral corticoids, 17% (3/18) had a pulse of methylprednisolone and 56% (10/18) were treated with cyclophosphamide. CONCLUSION: The prevalence of NPM in the patients of this study was on the lowest limit reported by the related literature. With no controlled clinical trials, the approach to these patients is based on case reports and the professional experience of the service