Korean J Intern Med.  2019 Mar;34(2):442-451. 10.3904/kjim.2016.383.

Clinical features and prognoses of acute transverse myelitis in patients with systemic lupus erythematosus

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. byoo@amc.seoul.kr

Abstract

BACKGROUND/AIMS
Acute transverse myelitis (ATM) is a severe complication of systemic lupus erythematosus (SLE). This study evaluated the clinical factors related to outcome in patients with SLE-associated ATM.
METHODS
The medical records of patients diagnosed with SLE-associated ATM between January 1995 and January 2015 were reviewed. The patients were divided into two groups based on improvement of neurological deficits after treatment: favorable response group and unfavorable response group. During follow-up, the recurrence of ATM was also analyzed.
RESULTS
ATM was identified in 16 patients with SLE. All of the patients were treated with high doses of methylprednisolone (≥ 1 mg/kg daily). Although 12 patients (75%) recovered (favorable response group), four (25%) had persistent neurologic deficits (unfavorable response group) after the treatment. Compared to the favorable response group, significantly higher Systemic Lupus Erythematosus Disease Activity Index-2000, lower complement levels and initial severe neurologic deficits were found in the unfavorable response group. Among the 12 favorable response patients, five (41.7%) experienced recurrence of ATM during the followup. Patients (n = 5) who experienced relapse had a shorter duration of high-dose corticosteroid treatment (13.2 days vs. 32.9 days, p = 0.01) compared to patients who did not relapse. The mean duration of tapering-off the corticosteroid until 10 mg per day was significantly longer in non-relapse group (151.3 ± 60.8 days) than in relapse group (63.6 ± 39.4 days, p = 0.013).
CONCLUSIONS
Higher disease activity in SLE and initial severe neurologic deficits might be associated with the poor outcome of ATM. Corticosteroid slowly tapering-off therapy might be helpful in preventing the recurrence of ATM.

Keyword

Lupus erythematosus, systemic; Lupus vasculitis, central nervous system; Myelitis, transverse

MeSH Terms

Complement System Proteins
Follow-Up Studies
Humans
Lupus Erythematosus, Systemic*
Lupus Vasculitis, Central Nervous System
Medical Records
Methylprednisolone
Myelitis, Transverse*
Neurologic Manifestations
Prognosis*
Recurrence
Complement System Proteins
Methylprednisolone
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