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Natural history of longitudinally extensive transverse myelitis in 35 Hispanic patients with systemic lupus erythematosus: good short-term functional outcome and paradoxical increase in long-term mortality
- Source :
- Lupus. 27:1279-1286
- Publication Year :
- 2018
- Publisher :
- SAGE Publications, 2018.
-
Abstract
- Background and objective Acute transverse myelitis (TM) is an infrequent neurological complication of systemic lupus erythematosus (SLE). Short-term outcome varies widely between cohorts. Little is known about the epidemiology and long-term functional outcome of TM associated to SLE. Methods Patients with SLE and acute TM were identified during hospital admission, visits to the Emergency Room or the Neurology Outpatient Clinic. We evaluated ambispectively those patients with SLE presenting with clinical myelopathy and corroborated with spinal MRI. Cases were divided as partial (non-paralyzing) or complete (paralyzing). We determined long-term functional outcome as well as mortality in those patients with follow-up periods of at least five years. Results We identified 35 patients (partial, n = 15; complete, n = 20) in which complete clinical and imaging data were available (26 with follow-up ≥ 5 years). Patients with complete TM were significantly older than those with partial forms. Positive antiphospholipid antibodies were observed in 80% of patients, suggesting a possible mechanistical role. Surprisingly, functional recovery at one year was in general good; however, we observed a five-year mortality of 31% because of sepsis (in 10 cases) or pulmonary embolism (in one case). Conclusions Short-term outcome of SLE-related TM is generally good, and recurrence rate is low. However, we observed a long-term fatality rate of 31% for reasons unrelated to TM, suggesting that TM is a manifestation of severe immune dysregulation and a predictor of severity and mortality in patients with SLE.
- Subjects :
- Adult
Male
Pediatrics
medicine.medical_specialty
Neurological complication
Myelitis, Transverse
Transverse myelitis
Tertiary Care Centers
Young Adult
03 medical and health sciences
0302 clinical medicine
Rheumatology
Azathioprine
Humans
Lupus Erythematosus, Systemic
Medicine
Mexico
030203 arthritis & rheumatology
business.industry
medicine.disease
Magnetic Resonance Imaging
Term (time)
Natural history
Prednisone
Female
Long term mortality
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 14770962 and 09612033
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- Lupus
- Accession number :
- edsair.doi.dedup.....4234133027b96d3ed5372bdc388fd9f5