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To the Editor:
We read the article by Joseph et al.1 with interest. The authors did not mention that roughly 30% to 90% of CNS-systemic lupus erythematosus (SLE) is associated with serum antineuronal antibodies compared to 5% to 20% in non-CNS-SLE. In addition, they do not mention that CSF IgG antineuronal antibodies (with specificity against lymphocytic, neuronal membrane, and neuronal intracellular antigens) can be found in up to 90% in CNS-SLE compared with 10% in non-CNS-SLE.3
These antibodies can be used as markers of CNS-SLE but only if found in CSF with direct binding to brain tissue. The amount of antibodies can be correlated with diffuse CNS manifestations like the 7 of 11 patients with normal scans who had headaches, meningism, memory impairment, and confusion.1–3 There is a report where one patient followed serially with CSF antineuronal antibodies had a decrease in activity of these antibodies when CNS-SLE was treated. During an exacerbation of CNS-SLE, the activity of these markers increased.3
Joseph et al.1 …
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