Tesis

Re-evaluasi Manifestasi Neuropsikiatri pada Lupus Eritematosus Sistemik di RSUPN dr. Cipto Mangunkusumo = Re-evaluation of Neuropsychiatric Manifestations in Systemic Lupus Erythematosus in Dr. Cipto Mangunkusuomo National Center, General Hopsital, Indonesia.

Latar Belakang. NPLES berspektrum luas, tidak spesifik, dan sulit dibedakan dari etiologi lain sehingga konsensus multidisiplin masih merupakan standar diagnosis. Reevaluasi manifestasi neuropsikiatri penting untuk mengurangi misklasifikasi dan meningkatkan akurasi diagnosis. Studi ini bertujuan untuk mendapatkan proporsi NPLES dan perbandingan karakteristik klinis serta penunjang antara NPLES dan non-NPLES di RSUPN dr Cipto Mangunkusumo setelah dilakuan re-evaluasi. Metode. Studi potong lintang dengan rekam medis di RSUPN dr. Cipto Mangunkusumo pada pasien LES bermanifestasi NP sejak Januari-Desember 2022. Dilakukan re-evaluasi oleh tim multidisiplin dan proporsi NPLES dihitung. Karakteristik klinis dan penunjang NPLES dan non-NPLES dibandingkan. Analisis univariat dan bivariat dilakukan sesuai kebutuhan. Hasil. Dari 94 subjek, terdapat 132 kasus manifestasi NP dan proporsi NPLES setelah reevaluasi 28%. Karakteristik demografis kedua kelompok tidak berbeda. Pada NPLES didapatkan nilai MEX-SLEDAI dengan (9 [1 -20], p < 0,001) dan tanpa NP (5[0- 19],p=0,02) lebih tinggi, proporsi penyakit LES aktif (OR 2,64 [1,1 -6,1], p=0,03), nilai numerik ISR (7[3-10]), p < 0,01), dan nilai anti-dsDNA (317,3 [3,4-1438,4] IU/mL, p < 0,001) lebih tinggi. Namun, nilai C3 (47 [12-148] mg/dL, p=0,018) dan C4 (8 [3-49] mg/dL, p=0,001) lebih rendah. Penyakit serebrovaskular cenderung lebih sering pada NPLES. Terdapat kecenderungan overdiagnosis NPLES nyeri kepala, bangkitan epileptik, delirium akut, dan mielopati dengan kecenderungan underdiagnosis NPLES pada penyakit serebrovaskular. Kendala utama studi adalah ketidaklengkapan data penunjang. Kesimpulan. Proporsi NPLES setelah re-evaluasi 28%. Kedua kelompok memiliki karakteristik demografi serupa. NPLES memiliki nilai MEX-SLEDAI dengan dan tanpa manifestasi NP, cenderung memiliki nilai ISR (median 7), kadar anti-dsDNA lebih tinggi dan status penyakit LES lebih aktif (2,6 kali), sedangkan kadar C3 dan C4 cenderung lebih rendah dibandingkan non-NPLES. Manifestasi serebrovaskular cenderung lebih sering pada NPLES. Ketidaklengkapan data berdampak pada kesulitan proses atribusi.
Kata Kunci: Karakteristik klinis; karakteristik penunjang; neuropsikiatri lupus eritematosus sistemik


Background. NPSLE consisted of various non-specific clinical syndromes that were difficult to differentiate from other etiologies, making multidisciplinary consensus the reference diagnostic standard. Re-evaluation of neuropsychiatric (NP) events is crucial to prevent misclassification and improve diagnostic accuracy. This study aimed to assess NPSLE after re-evaluating NP events in SLE and to compare the clinical and ancillary characteristics between NPSLE and non-NPSLE. Methods. A cross-sectional study using medical records at Dr. Cipto Mangunkusumo National Center General Hospital was conducted for NP manifestations cases in SLE patients from January to December 2022. The NPSLE proportion was calculated, and clinical and ancillary characteristics between NPSLE and non-NPSLE groups were compared. Univariate and bivariate analyses were performed as needed. Result. Out of 94 subjects, there were 132 NP events. After multidisciplinary reevaluation, the NPSLE proportion was 28%. There was no significant difference in demographic characteristics between NPSLE and non-NPSLE. In NPSLE, higher values of MEX-SLEDAI were found with (9 [1 -20], p < 0.001) and without NP (5[0-19], p=0.02), as well as a higher proportion of active disease (OR 2.64 [1.1 -6.1], p=0.03), ISR score (7 [3-10], p < 0.01), and anti-dsDNA titers (317.3 [3.4-1438.4] IU/mL, p < 0.001). On the other hand, lower values of C3 (47 [12-148] mg/dL, p=0.018) and C4 (8 [3-49] mg/dL, p=0.001) were observed in the NPSLE group compared to the non-NPSLE group. Cerebrovascular disease was more likely to be presented in NPSLE. There was a tendency to overly diagnose headache, epileptic seizures, acute confusional state, and myelopathy as NPSLE, while cerebrovascular disease tended to be underdiagnosed. The main limitation of this study was the incompleteness of ancillary test data Conclusion. The proportion of NPLES was 28%. NPSLE and non-NPSLE had similar demographic characteristics. The NPSLE group had higher values of MEX-SLEDAI (with and without NP), a higher proportion of active SLE disease (2.6 times), ISR score, and anti-dsDNA titers, with lower values of C3 and C4 compared to non-NPSLE. Data completeness resulted in difficulties in the attribution process of NP events in SLE.
Keywords.; ancillary characteristics; clinical characteristics; neuropsychiatric systemic lupus erythematosus