Clinical features and prognostic factors associated with neuropsychiatric manifestations of systemic lupus erythematosus in patients of the Kyrgyz population

Nervous system (NS) involvement in systemic lupus erythematosus (SLE) comprises a heterogeneous spectrum of neurological and psychiatric syndromes and represents one of the most severe disease manifestations, associated with a high risk of mortality.
Objective: to identify clinical characteristics and prognostic factors associated with neuropsychiatric manifestations of SLE (npSLE) in patients of the Kyrgyz population.
Material and methods. The study included 800 patients with a confirmed diagnosis of SLE who were followed at the clinic of the National Center of Cardiology and Therapy named after Academician Mirsaid Mirrakhimov from January 2012 to December 2024. Diagnosis of npSLE was performed according to the modified ACR 2001 classification criteria. Neurophysiological evaluation included electroencephalography, echoencephalography, and electroneuromyography. Structural neuroimaging of the brain was performed using magnetic resonance imaging and/or computed tomography.
Results and discussion. The prevalence of npSLE in the Kyrgyz cohort was 41%. Patients with npSLE were characterized by a higher frequency of acute disease course (41.2%; p=0.006), very high disease activity (p=0.0001), and irreversible organ damage (damage index >0 identified in 27.4% of cases; p<0.001). Severe depression (18.5%), polyneuropathy (7.5%), and psychosis (6.6%) were the most common npSLE manifestations. Independent predictors of npSLE development included high SLE activity, acute disease course, active lupus nephritis, respiratory system involvement, severe pulmonary arterial hypertension, fever, serositis, high damage index values, and C4 hypocomplementemia.
Conclusion. npSLE were identified in 41% of patients in the Kyrgyz cohort and represented the one of the first manifestations of the disease in 40% of cases, which may complicate the diagnosis of SLE. Severe depression (18.5%), polyneuropathy (7.5%), and psychosis (6.6%) were the most frequent npSLE variants. Independent predictors of npSLE included high disease activity, acute SLE course, active lupus nephritis, respiratory involvement, severe pulmonary arterial hypertension, fever, serositis, high damage index, and C4 hypocomplementemia.

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