Olfactory function in systemic lupus erythematosus and systemic sclerosis. A longitudinal study and review of the literature

Mariana Freschi Bombini; Fernando Augusto Peres; Aline Tamires Lapa; Nailú Angélica Sinicato; Beatriz Ricato Quental; Ágatha de Souza Melo Pincelli; Tiago Nardi Amaral; Caroline Cristina Gomes; Ana Paula Del Rio; João Francisco Marques-Neto; Lilian T L Costallat; Paula Teixeira Fernandes; Fernando Cendes; Leticia Rittner; Simone Appenzeller

doi:10.1016/j.autrev.2018.02.002

Olfactory function in systemic lupus erythematosus and systemic sclerosis. A longitudinal study and review of the literature

Autoimmun Rev. 2018 Apr;17(4):405-412. doi: 10.1016/j.autrev.2018.02.002. Epub 2018 Feb 11.

Authors

Mariana Freschi Bombini¹, Fernando Augusto Peres², Aline Tamires Lapa³, Nailú Angélica Sinicato³, Beatriz Ricato Quental⁴, Ágatha de Souza Melo Pincelli⁴, Tiago Nardi Amaral⁵, Caroline Cristina Gomes⁶, Ana Paula Del Rio⁷, João Francisco Marques-Neto⁷, Lilian T L Costallat⁷, Paula Teixeira Fernandes⁸, Fernando Cendes⁹, Leticia Rittner¹⁰, Simone Appenzeller¹¹

Affiliations

¹ Physiopathology Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil.
² Medicine Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil.
³ Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Child and Adolescent Health Graduate Program, School of Medical Sciences, University of Campinas, Brazil.
⁴ Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil.
⁵ Medicine Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil.
⁶ Undergraduate medical student-School of Medical Science-University of Campinas, Brazil.
⁷ Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil.
⁸ Department of Sports Sciences, School of Physical Education, University of Campinas, Brazil.
⁹ Medical Imaging Computing Laboratory, School of Electrical and Computer Engineering, University of Campinas, Brazil.
¹⁰ Department of Neurology, School of Medical Sciences, University of Campinas, Brazil.
¹¹ Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil. Electronic address: appenzel@unicamp.br.

PMID: 29444467
DOI: 10.1016/j.autrev.2018.02.002

Abstract

Background/purpose: To evaluate olfactory function in systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and healthy controls over a 2-year period, and to determine the association of olfactory dysfunction with age, disease activity, disease damage, treatment, anxiety and depression symptoms and limbic structures volumes.

Methods: Consecutive SLE and SSc patients were enrolled in this study. Clinical, laboratory disease activity and damage were assessed according to diseases specific guidelines. Olfactory functions were evaluated using the Sniffin' Sticks test (TDI). Volumetric magnetic resonance imaging (MRI) was obtained in a 3T Phillips scanner. Amygdalae and hippocampi volumes were analyzed using FreeSurfer® software.

Results: We included 143 SLE, 57 SSc and 166 healthy volunteers. Olfactory dysfunction was observed in 78 (54.5%) SLE, 35 (59.3%) SSc patients and in 24 (14.45%) controls (p<0.001) at study entry. SLE and SSc patients had significantly lower mean in all three phases (TDI) of the olfactory assessment when compared with healthy volunteers. In SLE, the presence of olfactory dysfunction was associated with older age, disease activity, higher anxiety and depression symptoms score, smaller left hippocampus volume, smaller left and right amygdalae volume and the presence of anti-ribosomal P (anti-P) antibodies. In SSc the presence of olfactory impairment was associated with older age, disease activity, smaller left and right hippocampi volumes and smaller right amygdala volume. Olfactory function was repeated after a 2-year period in 90 SLE, 35 SSc and 62 controls and was stable in all three groups.

Conclusion: Both SLE and SSc patients with longstanding disease had significant reduction in all stages of TDI that maintained stable over a 2-year period. Olfactory dysfunction was associated with age, inflammation and hippocampi and amygdalae volumes. In SLE, additional association with anti-P, anxiety and depression symptoms was observed.

Keywords: Autoimmunity; Central nervous system diseases; Olfaction; Olfactory dysfunction; Sense of smell; Systemic lupus erythematosus; Systemic sclerosis.

Publication types

Review

MeSH terms

Adult
Female
Humans
Longitudinal Studies
Lupus Erythematosus, Systemic / immunology*
Male
Scleroderma, Systemic / immunology*
Smell / physiology*