Current methods of diagnosis and treatment of neuropsychiatric disorders in systemic lupus erythematosus

Neuropsychiatric systemic lupus erythematosus (NPSLE) is a severe complication of systemic lupus erythematosus (SLE), characterized by damage to the nervous system. The article discusses the pathogenesis, clinical manifestations, laboratory and instrumental diagnostics, as well as modern and promising methods of treating NPSLE. Both immunoinflammatory (autoantibodies, cytokines) and ischemic (thrombosis, vasculitis) mechanisms are involved in the NPSLE pathogenesis. The clinical picture is varied and includes cognitive impairment, headache, seizures, psychosis, and other neurological and psychiatric symptoms. Diagnosis of NPSLE is difficult due to the lack of specific biomarkers. Both systemic markers (antibodies to dsDNA, Sm, SSA/Ro, SSB/La, aPL, anti-P, complement components) and nervous system-specific markers (antibodies to NR2, U1RNP, GAPDH, S100B, NfL, cytokines in CSF) are used. Instrumental diagnostics incorporates MRI, fMRI, MRS, DTI, PET, and SPECT. Treatment of NPSLE includes glucocorticoids, immunosuppressants, anticoagulants, and symptomatic therapy. Promising treatments include complement inhibitors, BBB repair therapies, MMPs inhibitors, IFN-α/β receptor antagonists, BTK inhibitors, S1P receptor modulators, ACE inhibitors, CSF1R inhibitors, and Nogo-A/NgR1 antagonists.