1460: Neuropsychiatric Lupus in Late and Early Onset Systemic Lupus Erythematosus Patients: A Systemic Review and Meta-analysis

Omer Pamuk¹, Saja Ali² and Sarfaraz Hasni², ¹NIH/NIAMS, Bethesda, MD, ²NIAMS/NIH, Bethesda, MD

Background/Purpose: The diagnosis of neuropsychiatric lupus (NPSLE) is challenging due to its variegated presentation, absence of diagnostic biomarkers and radiological imaging. The NPSLE is further challenging in older patients due to increased likelihood of alternate explanation for the underlying symptoms. Objective: We performed a systematic review and meta-analysis to evaluate the frequency and differences in NPSLE manifestations in late-onset ( >50 years-old) SLE patients (ltSLE) as compared to adult-onset (17-50 years) (aSLE) and childhood-onset SLE ( <16 years) (cSLE).

Methods: Literature search was performed using PubMed, Web of Science and Cochrane Library without any restrictions prior to May 2022. Studies were included fulfilled ACR 1997 revised classification criteria for SLE and ACR defined 1999 NPSLE syndromes. We excluded studies that did not include aSLE control group. Forest plot was used to compare odds ratios (95% CI) of NPSLE manifestations by age groups. Study heterogeneity was assessed using I².

Results: Total of 43 studies with 17913 aSLE and 2982 ltSLE patients were included in the study. A total of 3331 patients had NPSLE (aSLE= 2861 and ltSLE= 368). NPSLE frequency was more common in aSLE compared to ltSLE (OR: 1.43, 95% CI: 1.26-1.62, p< 0.001) (Figure 1). The seizures (OR: 1.69, 95% CI: 1.29-2.19) and psychosis (OR: 2.70, 95% CI: 1.79-4.07) were more common in aSLE (p values < 0.001), whereas peripheral neuropathy was less prevalent in aSLE then ltSLE (OR: 0.69, 95% CI: 0.50-0.97, p=0.03) (Figure 2). 13/43 studies reported the rate of NPSLE at the time of initial presentation which was similar in aSLE and ltSLE at the time of diagnosis (OR: 1.19, 95%CI: 0.88-1.61). 14/43 studies reported data on cSLE. NPSLE rate was more common in cSLE compared to ltSLE (OR: 1.53, 95%: 1.16-2.01, p=0.0027) (Figure 3), but similar to aSLE group (OR: 0.96, 95%CI: 0.81-1.15, p >0.05).

Conclusion: The overall rates of NPSLE were less common in ltSLE as compared to aSLE and cSLE. Peripheral neuropathy was more frequent, but seizures and psychosis were less common presentation in ltSLE. At the time of initial disease presentation, the frequency of NPSLE was similar in ltSLE and aSLE.
Figure 1. Odd ratios of CNS disease in late-onset versus early-onset SLE patients.

Figure 2. Odd ratios of peripheral neuropathy in late-onset versus early-onset SLE patients.
Disclosures: O. Pamuk, None; S. Ali, None; S. Hasni, None.