Inflammatory profile in cerebrospinal fluid of patients with headache as a manifestation of neuropsychiatric systemic lupus erythematosus.

Abstract

The objective of this study was to define the cytokine and chemokine profiles in cerebrospinal fluid (CSF) from patients with headache as neuropsychiatric systemic lupus erythematosus (NPSLE). In a post hoc analysis, seven patients hospitalized because of headache were included. Patients were evaluated at hospitalization and 6 months later and a CSF sample was obtained. As controls, CSF from 27 patients with other NPSLE syndromes, 16 SLE patients without a history of NP manifestations (non-NPSLE) and 25 patients with non-autoimmune diseases were studied. Soluble molecules including cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-α and IFN-γ) and chemokines [monocyte chemotactic protein-1, RANTES (regulated on activation normal T cell expressed and secreted), IL-8, monokine induced by IFN-γ (MIG), and IFN-γ-induced protein 10 (IP-10)] were measured with the use of cytometric bead array kits or luminometry. Patients with headache had increased CSF values in the following molecules compared with non-NPSLE and non-autoimmune diseases patients, respectively: IL-6 (208.5, 3.0, 3.0 pg/ml, P < 0.004 and P < 0.001), IL-8 (406.6, 30.0, 19.7 pg/ml, P < 0.05 and P < 0.004), IP-10 (4673, 329.7, 113.6 pg/ml, P = 0.02 and P < 0.002), RANTES (7.5, 2.5, 2.2 pg/ml, P < 0.003 for both) and MIG (944.7, 11.4, 3.5 pg/ml, P = 0.02 and P = 0.001). No clear difference was observed between patients with headache and other NPSLE. Higher levels of inflammatory molecules were found in patients with headache from intracranial hypertension and intractable non-specific headache than patients with migraine. Six months later, when the headache had resolved, all the elevated molecule levels had decreased significantly. Headache from intracranial hypertension and intractable non-specific headache, but not migraine, share the inflammatory profile in CSF observed in other NPSLE syndromes.