Neuropsychiatric involvement in SLE is heterogeneous. This protocol addresses the specific subgroup presenting with active neuropsychiatric manifestations that are atherothrombotic or antiphospholipid antibody (aPL)-mediated in nature — such as ischaemic stroke — where inflammatory neuropsychiatric features are absent.
Clinical scenario: Active neuropsychiatric SLE with atherothrombotic or antiphospholipid antibody-related manifestations (e.g. ischaemic stroke), in the absence of inflammatory neuropsychiatric manifestations.
Treatment approach: Management in this vascular/aPL-mediated subtype focuses on antiplatelet or anticoagulant therapy — the choice between them, selection criteria, and the full clinical algorithm are contained in the complete protocol.
DOI: 10.1136/ard-2023-224762
In active neuropsychiatric disease attributed to SLE, glucocorticoids and immunosuppressive agents for inflammatory manifestations (1b/A) and antiplatelet agents/anticoagulants for atherothrombotic/aPL-related manifestations (2b/C) should be considered.
Anticoagulant treatment is mainly indicated in cases of cerebrovascular disease, such as ischaemic stroke associated with aPL, because its value in other manifestations is not clear.
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