Nitrated nucleosome levels and neuropsychiatric events in systemic lupus erythematosus; a multi-center retrospective case-control study

Isabel Ferreira, Sara Croca, Maria Gabriella Raimondo, Manjit Matharu, Sarah Miller, Ian Giles, David Isenberg, Yiannis Ioannou, John G. Hanly, Murray B. Urowitz, Nicole Anderson, Cynthia Aranow, Anca Askanase, Sang-Cheol Bae, Sasha Bernatsky, Ian N. Bruce, Jill Buyon, Ann E. Clarke, Mary Anne Dooley, Paul Fortin, Ellen Ginzler, Dafna Gladman, Caroline Gordon, Murat Inanc, Søren Jacobsen, Kenneth Kalunian, Diane Kamen, Munther Khamashta, Sam Lim, Susan Manzi, Joan Merrill, Ola Nived, Christine Peschken, Michelle Petri, Rosalind Ramsey-Goldman, Guillermo Ruiz-Irastorza, Jorge Sanchez-Guerrero, Kristjan Steinson, Gunnar K. Sturfelt, Ronald van Vollenhoven, Daniel J. Wallace, Asad Zoma, Anisur Rahman

In patients with systemic lupus erythematosus (SLE) there is no serological test that will reliably distinguish neuropsychiatric (NP) events due to active SLE from those due to other causes. Previously we showed that serum levels of nitrated nucleosomes (NN) were elevated in a small number of patients with NPSLE. Here we measured serum NN in samples from a larger population of patients with SLE and NP events to see whether elevated serum NN could be a marker for NPSLE. We obtained serum samples from patients in the Systemic Lupus International Collaborative Clinics (SLICC) inception cohort. This included 216 patients with NP events and two matched controls with SLE but no NP events for each of these patients. For the NP patients we tested samples taken before, during and after the NP event. Twenty-six patients had events attributed to SLE according to the most stringent SLICC attribution rule. In these patients there was no association between onset of event and elevated serum NN. In 190 patients in whom events were not attributed to SLE by the SLICC rules, median serum NN was elevated at the onset of event (P = 0.006). The predominant clinical features in this group of 190 patients were headache, mood disorders and anxiety. Serum NN levels rise at the time of an NP event in a proportion of patients with SLE. Further studies are needed to determine the value of serum NN as a biomarker for NPSLE.