Neuropsychiatric systemic lupus erythematosus: Pathophysiology and the future of treatment

Systemic lupus erythematosus (SLE) is characterized by the presence of several autoantibodies, including anti-dsDNA. Among types of SLE, neuropsychiatric (NP)-SLE accounts for significant morbidity and mortality. Cerebrovascular disease, which could account for most of the serious permanent neurological damage, is a common presentation of NP-SLE. The pathophysiology of NP-SLE involves several factors, including vasculitis, thrombosis, and inflammation and/or apoptosis of neuronal and glial cells. The current treatment strategy is immunosuppressive therapy, which is occasionally insufficient for patients with NP-SLE. Recent studies have revealed that autoantibodies, such as anti-NR2, pass from the peripheral blood to the brain through the blood-brain barrier, cross-react with human brain tissue and cause increased intracellular Ca²⁺ in SLE. Regulating blood-brain barrier permeability, inhibiting autoantibody deposition in tissues and modulating intracellular Ca²⁺ may be new concepts for the treatment with NP-SLE.