{
  "abstract": "Objectives The present study aimed to evaluate the clinical, immunological, and radiological features of NPSLE in a Moldovan cohort, and to analyze the associations with autoantibodies and blood-brain barrier (BBB) disruption.Methods A cross-sectional observational study was conducted on 17 consecutive female patients with established SLE admitted between 2018-2024 at Rheumatology Clinic of Nicolae Testemitanu University. Mean age was 36.4 ± 8.2 years (range 22-52), with a mean age at disease onset of 28.7 ± 6.9 years and mean disease duration of 7.6 ± 3.8 years. NPSLE was classified according to ACR criteria. Clinical and serological profiles included ANA, anti-dsDNA, anti-ribosomal P, anti-NMDAR, and antiphospholipid antibodies (aPL). Disease activity was assessed using SLEDAI-2K. Cerebrospinal fluid (CSF) studies and neuroimaging were performed when indicated. Statistical analyses employed χ 2 tests and Spearman correlations.Results Neuropsychiatric manifestations were present in all 17 patients, with diffuse syndromes predominating (59%) over focal events (41%). Cognitive dysfunction (41.2%) and mood disorders (35.3%) were the most frequent, followed by seizures (29.4%), psychosis (17.6%), and cerebrovascular events (11.8%). The mean SLEDAI-2K score was 13.9 ± 4.1, significantly higher than in SLE controls without NPSLE (p=0.02). Anti-dsDNA antibodies were detected in 82.4% of patients and correlated with disease activity (r=0.46, p<0.05). Anti-ribosomal P antibodies were positive in 23.5% and strongly associated with psychosis (OR 4.2, 95% CI 1.1-16.7). Anti-NMDAR antibodies were identified in 29.4% and correlated with cognitive impairment (r=0.52, p<0.05). Antiphospholipid antibodies were present in 23.5%, associated with ischemic stroke and recurrent headaches. CSF analysis (n=7) revealed elevated IL-6 levels in 71.4% and increased QAlb in 57.1%, both linked to diffuse syndromes. MRI abnormalities were documented in 35.3% of patients, including ischemic lesions (23.5%) and hippocampal atrophy (11.8%).Conclusions The spectrum of manifestations highlighted the predominance of cognitive and affective disorders, with psychosis and seizures linked to brain-specific autoantibodies. BBB dysfunction markers (IL-6, QAlb) and neuroimaging abnormalities supported the inflammatory-ischemic dual mechanism of pathogenesis. These findings reinforce the role of combined biomarker and imaging strategies for accurate attribution and management of NPSLE. Larger prospective studies are warranted to validate multi-marker panels for personalized diagnostic algorithms.",
  "authors": [
    {
      "affiliations": [
        "Nicolae Testemitanu State University of Medicine and Pharmacy – Department of Rheumatology and Nephrology, Chisinau, Republic of Moldova"
      ],
      "name": "Serghei Popa"
    },
    {
      "affiliations": [
        "Nicolae Testemitanu State University of Medicine and Pharmacy – Department of Rheumatology and Nephrology, Chisinau, Republic of Moldova"
      ],
      "name": "Eugeniu Russu"
    },
    {
      "affiliations": [
        "Nicolae Testemitanu State University of Medicine and Pharmacy – Department of Rheumatology and Nephrology, Chisinau, Republic of Moldova"
      ],
      "name": "Lia Chislari"
    }
  ],
  "title": "PO:09:228 Neuropsychiatric systemic lupus erythematosus: clinical spectrum, autoantibody profiles, and blood-brain barrier dysfunction in a Moldovan cohort",
  "uid": "4fe21354-dff3-5374-b78b-ccbb6378f5d4"
}