Magnetic Resonance Imaging-Negative Lupus Myelitis: A Narrative Review

Magnetic resonance imaging (MRI)-negative lupus myelitis (MNLM) is a rare neurological manifestation of systemic lupus erythematosus (SLE). Diagnosing MNLM without prior systemic involvement remains challenging. This review aims to analyze all published cases and compare MNLM patients with (Group A) and without prior SLE diagnosis (Group B), emphasizing on demographic and clinical profiles, treatment, and outcomes. A PubMed literature review on MNLM was conducted. Demographic profile, clinical presentations, and management were analyzed. MNLM patients were categorized into Group A and B and compared using univariate and multivariate comparison methods, where a P value <0.05 was considered significant. In total, 41 cases were analyzed. The cohort was predominantly female (8:1 ratio, mean age 31.22 ± 11.91 years, range 15-59 years). Thoracic cord involvement was the most common (55%), with myelitis presenting as the first manifestation in 49% of patients. Clinical presentations were predominantly subacute (71%) with partial tract involvement in 63%. Group A demonstrated significantly higher cervical cord localization (P = 0.019) compared to Group B's thoracic involvement (P = 0.041). Antiphospholipid syndrome (APS) antibody-positive patients showed 3.2-fold higher odds for partial recovery (P = 0.16). Logistic regression analysis identified Anti Smith/ Ribonucleoprotein/ Ribosomal (Sm/RNP/Rib) antibodies as independent risk factors for poor complete recovery (odds ratio (OR) = 0.61), whereas cervical cord localization independently improved odds for complete recovery (OR = 3.2). MNLM presents with variable clinical manifestations suggesting selective tract involvement. Group A exhibits higher cervical involvement, while Group B shows predominantly thoracic involvement. APS antibodies favor partial recovery, cervical localization predicts complete recovery, and Sm/RNP/Rib antibodies are independent predictors of poor recovery outcomes.