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SLE neuropsychiatric disease — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesSLE neuropsychiatric diseaseSCE Rheumatology

A 35-year-old woman with SLE develops a first generalised seizure and confusion. She has low complement and high anti-dsDNA. Blood pressure is normal, glucose is normal and CT head is unremarkable. She is taking hydroxychloroquine and low-dose prednisolone. What is the most appropriate investigation?

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Reveal the answer and explanation

Correct answer: B — MRI brain, CSF analysis and exclusion of infection

Explanation lettering: D = shown as A · A = shown as B · B = shown as D

MRI brain, CSF analysis and exclusion of infection is best because new neuropsychiatric symptoms in SLE require urgent assessment, including MRI and CSF where appropriate, while excluding infection and metabolic causes. B is less suitable because assuming lupus without investigation risks missing infection or thrombosis; C is less suitable because thrombolysis is not indicated without acute ischaemic stroke criteria; D is less suitable because salivary gland biopsy is for Sjögren disease classification; E is less suitable because RF titre does not evaluate seizures. Clinical pearl: neuropsychiatric SLE is a diagnosis of attribution after mimics are actively excluded.

Reference: EULAR SLE recommendations 2023; BSR lupus guideline