Clinical features of Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuritis associated with SLE.

Objective: We report on the clinical characteristics, treatments and outcomes of Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuritis (CIDP) associated with SLE.

Methods: Patients treated at Peking Union Medical College Hospital between January 2004 and November 2021 who fulfilled the diagnostic criteria for SLE and GBS/CIDP (n=9) were included. Clinical presentations, lab results, treatment regimens and prognoses were retrieved and analysed.

Results: Six patients were diagnosed with SLE and GBS, while three were diagnosed with SLE and CIDP, with the average age at diagnosis of 38.6±18.2 years. SLE disease duration ranges from 1 week to 36 years, and the courses of GBS and CIDP range from 1 week to 2 months and from 2 months to 15 months, respectively. All patients exhibited either or both limb paresthesia and weakness, other neurological symptoms include dysphagia, peripheral facial nerve palsy and respiratory and cardiac arrest. The median cerebral spinal fluid white blood cell count and protein level were 0.002×10⁹/L (0-0.006×10⁹/L) and 0.79 g/L (0.57-7.09 g/L), respectively. All patients received glucocorticoid and immunoglobulin therapy. Seven patients received cyclophosphamide, and seven patients received intrathecal injections of methotrexate and dexamethasone. Two patients had complete resolution, five experienced marked improvements and two failed to improve with treatments.

Conclusion: SLE-associated GBS/CIDP may manifest regardless of disease systemic activity. Clinical features may differ from that of pure GBS/CIDP, and treatment often requires immunosuppressants, making differential diagnosis crucial, especially for patients with GBS/CIDP presenting as the first manifestation of SLE.