Clinical studies on anti-RNP and anti-Sm antibodies Part 2. Clinical and serological study of central nervous system disease in patients with systemic lupus erythematosus, and the relationship to antibodies of ribonucleoprotein

Forty of 150 (27%) patients with systemic lupus erythematosus (SLE) had central nervous system (CNS) disease including psychosis (24), seizure (10), coma (2), meningitis (3) and blindness (1). Raynaud's phenomenon (60%) and antibody to ribonucleoprotein (RNP) (78%) were significantly more common in the CNS SLE group than non-CNS SLE group. On the contrary, LE cell (40%) and clinical renal disease (43%) were less common in the CNS SLE group than the non-CNS SLE group. At the onset of CNS disease, the incidence of elevated n-DNA binding (35%) and decreased CH50 (35%) were significantly lower than in patients without CNS disease. Anti-RNP was present in 78% of the patients at the onset of CNS disease and 47% of the patients without CNS disease; this difference was significant (p<0.002). Anti-RNP in CSF was demonstrated by the precipitin reaction in 7 patients at the onset of CNS disease. Anti-Sm in CSF was found in only one patient with CNS disease. Enrichment of anti-RNP in CSF over the serum level was demonstrated in 3 patients. Seventy percent of the CNS episodes began within 8 weeks of the initiation or increase in dose of corticosteroids, including 9 patients within the 1st week, 9 during the 2nd week, 2 during the 3rd week, 5 during the 4th week and 3 during the 5th to 8th week. These data suggest a high incidence of CNS episodes in patients with SLE and anti-RNP after increasing the corticosteroid dosage.