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ACR Special Report: Philadelphia, PA, October 18-21, 2009

Introduction
Highlights of the American College of Rheumatology 2010 Annual Scientific Meeting
The Latest Treatment Advances for Lupus
Treatment May Prevent Neonatal Lupus
The Brain and Lupus: 2010 Update
Risk of Some Cancers Double in Lupus
Assessing the Cost of Lupus
From the Lab to the Clinic: Lessons Learned About Lupus
ALR-Supported Research Focus of Plenary Session

The Brain and Lupus: 2010 Update

Neuropsychiatric manifestations of lupus include headache, cognitive dysfunction, mood disorders, cerebrovascular events (i.e., stroke), seizures, polyneuropathy, anxiety, and psychosis. It’s difficult, however, for clinicians to know what is caused by lupus and what may have existed before lupus or despite lupus.

What is important, said John Hanly, MD, of Dalhousie University in Halifax, Nova Scotia, Canada, is teasing out those symptoms that began before the lupus diagnosis (i.e., migraines) and those that are likely related to the lupus or its treatment, i.e., stroke. He and his colleagues published a seminal paper on the topic in 2007 in which they assessed 572 patients recently diagnosed with lupus. They found that about a third had at least one neuropsychiatric event, with 10% exhibiting more than one. Events attributed to lupus occurred in 6% to 12% of patients (depending on how the association was determined). No matter what caused the patients’ neuropsychiatric event, however, all demonstrated reduced quality of life and increased organ damage compared to a similar cohort with no neuropsychiatric events.xv

There are likely numerous underlying causes of these events, Dr. Hanly said, including the effect of lupus on blood vessels (which can affect blood flow to the brain); autoantibodies and inflammatory mediators. For instance, some studies show that injecting autoantibodies into the brain leads to memory deficits, seizures, and neuropathological changes. It is possible that the blood/brain barrier that typically protects the brain against such invasion is weaker in patients with lupus, enabling certain autoantibodies to penetrate into the brain.

Other than aspirin or other antithrombotic therapies to prevent stroke, only symptomatic therapies are available for most neuropsychiatric indications, including anticonvulsants, anti-psychotics, anxiolytics, and immunosuppression to reduce inflammation, all with mixed evidence as to their benefits. Rituximab is being tried in some centers to treat neuropsychiatric lupus, he said, and while the evidence is “not robust... it is the best we have at this stage.”

Key point: Whether depression, anxiety, cognitive problems, or other neuropsychiatric conditions are caused by lupus or result from other issues, they should be treated aggressively given their effect on quality of life and overall disease status.


More information about lupus and treatment advances can be found by visiting www.lupusresearch.org.

The 2010 American College of Rheumatology Meeting Special Report was made possible in part by generous support from Biogen Idec, Genentech and Johnson & Johnson.

©2010 Alliance for Lupus Research. All Rights Reserved.

Contents herein may not be reproduced, republished or distributed without the prior written permission of the Alliance for Lupus Research. To request permission to reproduce, republish or distribute any part of this report, contact us at 212-218-2840 or email info@lupusresearch.org.


i Bingham CO, et al. Citrullination and Peptidylarginine Deiminase (PAD) Expression Is Detected in the Oral Mucosa and Periodontium in the Absence of Rheumatoid Arthritis.
ii Scher JU, et al. Characteristic Oral and Intestinal Microbiota in Rheumatoid Arthritis (RA): A Trigger for Autoimmunity?
iii Merrill JT, et al. Five-Year Experience with Belimumab, a BLyS-Specific Inhibitor, in Patients with Systemic Lupus Erythematosus (SLE).
iv Vollenhoven RF, et al. Belimumab, a BLyS-Specific Inhibitor, Reduced Corticosteroid Use in Patients with Active SLE: Results from the Phase 3 BLISS-52 and -76 Studies.
v Petri MA, et al. Belimumab, a BLyS-Specific Inhibitor, Reduced Disease Activity, Flares, and Prednisone Use in Patients with Seropositive SLE: Combined Efficacy Results from the Phase 3 BLISS-52 and -76 Studies.
vi Chatham WW. Effect of Belimumab, a B-Lymphocyte Stimulator–Specific Inhibitor, on Functional Antibodies to Pneumococcal, Tetanus, and Influenza Vaccines.
vii Stohl W. Belimumab, a BLyS-Specific Inhibitor, Significantly Reduced Autoantibodies, Normalized Low Complement, and Reduced Selected B-Cell Populations in Patients with Seropositive Systemic Lupus Erythematosus (SLE): The Phase 3 BLISS Studies.
viii Wallace DJ, et al. Epratuzumab Demonstrates Clinically Meaningful Improvements in Patients with Moderate to Severe Systemic Lupus Erythematosus (SLE): Results from EMBLEM™, a Phase IIb Study.
ix Kalunian KC, et al. BILAG-Measured Improvement in Moderately and Severely Affected Body Systems in Patients with Systemic Lupus Erythematosus (SLE) by Epratuzumab: Results from EMBLEM™, a Phase IIb Study.
x Sullivan BA, et al. A Flow Cytometric Receptor Occupancy Assay Demonstrates Dose-Dependent Blockade of B7RP-1 by AMG 557 on Circulating B Cells from SLE Subjects.
xi Fleischmann RM. Evidence of Peripheral B Cell Depletion in Subjects with Controlled Systemic Lupus Erythematosus (SLE) Following Subcutaneous Administration of SBI-087.
xii Salwsky KA, et al. A Systematic Literature Review of the Direct Costs of Systemic Lupus Erythematosus (SLE) in the United States (US).
xiii McBurney CA. Platelet C4d Is Associated with All-Cause Mortality in Patients with Systemic Lupus Erythematosus.
xiv Bernatsky SR, et al. Further Defining Cancer Risk in Systemic Lupus: Updated Results in an Expanded International Multi-Centre Cohort
xv Hanly JG, Urowitz MB, Sanchez-Guerrero J, et al. Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: an international inception cohort study. Arthritis Rheum. 2007;56(1):265-73.
xvi Izmirly PM, et al. Hydroxychloroquine and Prevention of Anti-SSA/Ro Associated Cardiac Disease in Mothers with a Previous Child with Neonatal Lupus
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