Journal Article

DZNE-2024-00509

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Association of rheumatological markers with neuronal antibodies, cerebrospinal fluid, electroencephalography, and magnetic resonance imaging findings in 224 patients with psychotic syndromes

Endres, D. ; von Zedtwitz, K. ; Nickel, K. ; Runge, K. ; Maier, A. ; Domschke, K. ; Salzer, U. ; Prüss, H.DZNE* ; Venhoff, N. ; van Elst, L. T.

2024
Academic Press Orlando, Fla.

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Please use a persistent id in citations: doi:10.1016/j.bbi.2024.04.001

Abstract: Psychotic syndromes can have autoimmune-mediated causes in some patients. Thus, this retrospective work aims to investigate the role of rheumatological markers in the development of psychosis.In total, 224 patients with psychotic syndromes receiving a 'rheumatological laboratory screening' (including C-reactive protein [CRP], immunofixation, complement factors, rheumatoid factor [RF], antiphospholipid antibodies [APAs], antineutrophil cytoplasmic antibodies [ANCAs], and antinuclear antibodies [ANAs]) were analyzed. A further diagnostic work-up included investigations of neuronal antibodies and cerebrospinal fluid (CSF), as well as electroencephalography (EEG) and magnetic resonance imaging (MRI) of the brain. ANA testing was routinely performed in all patients using serum on human epithelioma-2 (Hep2) cells, and a subset of patients (N = 73) also underwent tissue-based assays from serum and CSF. The number of cases with autoimmune psychotic syndromes was descriptively collected, and ANA-positive and -negative patients were compared in detail.CRP was elevated in 9 % of patients, immunofixation identified alterations in 8 %, complement factor C3 was decreased in 14 %, RF was elevated in 1 %, APAs were elevated in 7 %, ANCAs were not clearly positive, and ANAs were positive in 19 % (extractable nuclear antigen [ENA] differentiation resulted in positive findings in 14 patients). From the 73 patient samples additionally investigated using tissue-based assays, there were 26 positive results for some kind of ANA (36 %), and overall using both methods, 54 patients (24 %) were considered positive for ANAs. A neuropsychiatric evaluation revealed a possible autoimmune psychotic syndrome in seven patients (3 %) and a probable autoimmune psychotic syndrome in two patients (1 %). ANA-positive patients were more frequently treated with antidepressants (p = 0.040) and had a higher number of somatic comorbidities (p < 0.001). In addition, (chronic) inflammatory MRI lesions (p = 0.008) and focal atrophies (p = 0.012) were found more frequently in ANA-positive than ANA-negative patients.Rheumatological screening led to suspicion of a possible or probable autoimmune psychotic syndrome in 4%. ANAs were associated with MRI pathologies. Therefore, rheumatological processes may contribute to the development of psychotic syndromes in rare cases.

Keyword(s): Humans (MeSH) ; Psychotic Disorders: immunology (MeSH) ; Male (MeSH) ; Female (MeSH) ; Adult (MeSH) ; Electroencephalography: methods (MeSH) ; Middle Aged (MeSH) ; Magnetic Resonance Imaging: methods (MeSH) ; Retrospective Studies (MeSH) ; Biomarkers: cerebrospinal fluid (MeSH) ; Biomarkers: blood (MeSH) ; C-Reactive Protein: analysis (MeSH) ; C-Reactive Protein: metabolism (MeSH) ; Autoantibodies: cerebrospinal fluid (MeSH) ; Autoantibodies: blood (MeSH) ; Antibodies, Antinuclear: cerebrospinal fluid (MeSH) ; Aged (MeSH) ; Brain: diagnostic imaging (MeSH) ; Brain: metabolism (MeSH) ; Young Adult (MeSH) ; Autoimmune Diseases: cerebrospinal fluid (MeSH) ; Neurons: metabolism (MeSH) ; Adolescent (MeSH) ; Rheumatic Diseases: cerebrospinal fluid (MeSH) ; ANA ; Antibody ; Autoimmune psychosis ; Complement ; Immunological ; Biomarkers ; C-Reactive Protein ; Autoantibodies ; Antibodies, Antinuclear

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Contributing Institute(s):

1. Autoimmune Encephalopathies (AG Prüß)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

Appears in the scientific report 2024

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Database coverage:
; ; ; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Life Sciences ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 15 ; JCR ; Nationallizenz ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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