Decade-Long Study on Phenotype and Prognosis of Lupus Myelitis (LM) in Systemic Lupus Erythematosus (SLE): Insights from a Single-Centre in India

Background: Systemic lupus erythematosus (SLE)-associated myelitis or lupus myelitis (LM), one of the twelve neuropsychiatric lupus (NPSLE) syndromes, is a rare but severe complication of lupus. In this study, we observed the clinical and imaging profiles of LM patients to assess long-term outcomes. Methods: This was a retrospective study; data of LM with follow-up were extracted from the lupus registry in the last 15 years (2007-2022). Clinically, they were divided as grey matter myelitis (GMM) versus white matter myelitis (WMM). Disease activity was assessed by the SLE Disease Activity Index (SLEDAI-2K) & outcome by death, recurrence, and modified Rankin Score (MRS). Survival analysis was performed using the Kaplan-Meier (KM) and Weibull survival probability tests. Results: 38 patients were included out of 1700 lupus patients over the last 15 years. Among them, 26 patients presented with GMM, and 12 presented with WMM. Patients with GMM had significantly higher SLEDAI and MRS at discharge compared to WMM patients. (P-value-.021 and .08, respec-tively). White matter myelitis patients had higher levels of anti-cardiolipin antibodies. (P-.005) MRI-positive myelitis was associated with higher dsDNA levels compared to MRI-negative myelitis (P-.03), but there was no significant difference in disease activity or outcome. The Weibull probability plot indicated poor survival status in GMM. Conclusion: The prevalence of LM in our cohort is around 2%. Grey matter myelitis is associated with more active disease and significant disability. Survival analysis revealed a poor outcome for GMM in this study.