A significant manifestation of systemic lupus erythematosus (SLE) is neuropsychiatric lupus (NPSLE), which can involve both the central and peripheral nervous systems. NPSLE includes a range of neurological symptoms, such as cognitive dysfunction, psychosis, seizures, strokes, and peripheral neuropathy. The pathophysiology of NPSLE is complex and involves autoimmune processes, where autoantibodies target neural tissues and cause neuroinflammation. The complement system and genetic factors also contribute to the development of these neurological complications. Diagnosis of NPSLE is challenging due to the lack of specific biomarkers and the overlap of symptoms with other conditions, making early detection critical for preventing irreversible damage.
Management of NPSLE requires a multidisciplinary approach, including immunosuppressive treatments such as corticosteroids, cyclophosphamide, and rituximab. Anticoagulation therapy is essential for ischemic events associated with antiphospholipid syndrome (APS). While corticosteroids remain the first-line treatment for acute symptoms, other immunosuppressants and biologics are used for refractory cases. Despite advancements in treatment, NPSLE remains a significant challenge in clinical practice due to its impact on patients’ quality of life and the complexities involved in its diagnosis and management. Continued research into the pathophysiology of NPSLE, along with the development of specific biomarkers, is essential for improving patient outcomes and treatment strategies.
Reference: Jayasinghe M, Rashidi F, Gadelmawla AF, et al. Neurological Manifestations of Systemic Lupus Erythematosus: A Comprehensive Review. Cureus. 2025 Feb 24;17(2):e79569. doi: 10.7759/cureus.79569. PMID: 40151747; PMCID: PMC11947500.
