Transverse Myelitis Affecting More Than 4 Spinal Segments Associated with Systemic Lupus Erythematosus: Clinical, Immunological, and Radiological Characteristics of 22 Patients

• Published in: Seminars in arthritis and rheumatism 2010-02, Vol.39 (4), p.246-256
• Main Authors: Espinosa, Gerard, MD, PhD, Mendizábal, Andrea, MD, Mínguez, Sonia, MD, Ramo-Tello, Cristina, MD, Capellades, Jaume, MD, IDI, Olivé, Alejandro, MD, PhD, Cervera, Ricard, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age of Onset; Antirheumatic Agents - therapeutic use; Biological and medical sciences; Child; Cyclophosphamide - therapeutic use; Diseases of the osteoarticular system; Drug Therapy, Combination; Female; Glucocorticoids - therapeutic use; Humans; longitudinal involvement of transverse myelitis; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - immunology; Magnetic Resonance Imaging; Male; Medical sciences; Methylprednisolone - therapeutic use; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; myelitis; Myelitis, Transverse - drug therapy; Myelitis, Transverse - etiology; Myelitis, Transverse - immunology; myelopathy; Neurology; Retrospective Studies; Rheumatology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Spinal Cord - immunology; systemic lupus erythematosus; Treatment Outcome
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2008.09.002

Objective To analyze the clinical and laboratory characteristics and outcomes of patients with transverse myelitis affecting more than 4 spinal segments secondary to systemic lupus erythematosus (SLE). Methods A computer-assisted (PubMed) search of the literature was performed to identify all cases of transverse myelitis affecting more than 4 spinal segments secondary to SLE from 1966 to April 2008. In addition, we present 2 previously unreported cases of SLE patients with transverse myelitis affecting more than 4 spinal segments. Results Twenty-two SLE patients with transverse myelitis affecting more than 4 spinal segments were finally reviewed. There were 17 (77%) females and the mean age at the diagnosis of myelitis was 29.3 ± 9.4 years (range, 12-53 years). It was the first manifestation of SLE in 5 (23%) patients. The most frequent clinical manifestations were sensory deficit in 20 (91%) patients, variable motor deficit in 19 (86%), and urinary sphincter dysfunction in 15 (83%) patients. On magnetic resonance imaging, all patients showed increased T2 signal intensity of the spinal cord, most frequently in the cervical to mid-lower thoracic spinal segments. Most patients received a combination of therapies; corticosteroids and cyclophosphamide was the most common (45%). Three patients (14%) had complete resolution of symptoms and 14 (59%) had partial recovery. Conclusions Transverse myelitis affecting more than 4 spinal segments is a rare complication in patients with SLE but may be the first clinical manifestation of the disease in some patients. A high proportion of affected patients have variable degrees of disability after treatment.