NPSLE Chorea — RACP Adult Medicine MCQ

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HardRheumatologyNPSLE ChoreaRACP Adult Medicine

A 42-year-old woman with SLE develops new onset chorea, personality change, and psychosis. MRI brain shows no structural lesion. Her antiphospholipid antibodies are strongly positive. CSF is normal. What is the most likely neuropsychiatric SLE (NPSLE) manifestation?

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Correct answer: D — Steroid-induced psychosis

Neuropsychiatric SLE (NPSLE) encompasses a spectrum of manifestations. Chorea in SLE is strongly associated with antiphospholipid antibodies (occurring in ~2% of SLE patients with aPL). The mechanism is thought to involve antibody-mediated basal ganglia dysfunction and/or small vessel thrombosis. Treatment includes anticoagulation (if aPL-related), aspirin, and sometimes corticosteroids or immunosuppression. Psychosis in NPSLE may be due to autoantibody-mediated neuronal dysfunction or vasculopathy. CSF analysis, MRI, and exclusion of infection are essential before attributing symptoms to NPSLE.

Reference: eTG – 2025 – Rheumatology; ACR – 1999 – NPSLE Nomenclature