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Implications of Inflammatory Processes on a Developing Central Nervous System in Childhood-Onset Systemic Lupus Erythematosus.
van der Heijden, Hanne; Rameh, Vanessa; Golden, Emma; Ronen, Itamar; Sundel, Robert P; Knight, Andrea; Chang, Joyce C; Upadhyay, Jaymin.
Afiliación
  • van der Heijden H; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, and University of Amsterdam, Amsterdam, The Netherlands.
  • Rameh V; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Golden E; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Ronen I; Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
  • Sundel RP; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Knight A; The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
  • Chang JC; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Upadhyay J; Boston Children's Hospital, Harvard Medical School, Boston and McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
Arthritis Rheumatol ; 76(3): 332-344, 2024 Mar.
Article en En | MEDLINE | ID: mdl-37901986
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is increasingly affecting pediatric and adult populations. Neuropsychiatric manifestations (ie, cognitive dysfunction and mood disorders) appear to occur with greater severity and poorer prognosis in childhood-onset SLE (cSLE) versus adult-onset SLE, negatively impacting school function, self-management, and psychosocial health, as well as lifelong health-related quality of life. In this review, we describe pathogenic mechanisms active in cSLE, such as maladaptive inflammatory processes and ischemia, which are hypothesized to underpin central phenotypes in patients with cSLE, and the role of alterations in protective central nervous system (CNS) barriers (ie, the blood-brain barrier) are also discussed. Recent findings derived from novel neuroimaging approaches are highlighted because the methods employed in these studies hold potential for identifying CNS abnormalities that would otherwise remain undetected with conventional multiple resonance imaging studies (eg, T2-weighted or fluid-attenuated inversion recovery sequences). Furthermore, we propose that a more robust presentation of neuropsychiatric symptoms in cSLE is in part due to the harmful impact of a chronic inflammatory insult on a developing CNS. Although the immature status of the CNS may leave patients with cSLE more vulnerable to harboring neuropsychiatric manifestations, the same property may represent a greater urgency to reverse the maladaptive effects associated with a proneuroinflammatory state, provided that effective diagnostic tools and treatment strategies are available. Finally, considering the crosstalk among the CNS and other organ systems affected in cSLE, we postulate that a finer understanding of this interconnectivity and its role in the clinical presentation in cSLE is warranted.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Disfunción Cognitiva / Lupus Eritematoso Sistémico Límite: Adult / Child / Humans Idioma: En Revista: Arthritis Rheumatol Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Disfunción Cognitiva / Lupus Eritematoso Sistémico Límite: Adult / Child / Humans Idioma: En Revista: Arthritis Rheumatol Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos