Cerebrospinal Fluid Autoantibody Profiles in Rheumatologic Disorders Affecting the Central Nervous System: A Systematic Review

Rheumatologic disorders affecting the central nervous system (CNS) can cause significant neurological and psychiatric morbidity. Early detection of CNS involvement is essential to prevent irreversible damage. This study aims to systematically review cerebrospinal fluid (CSF) autoantibody profiles in rheumatologic disorders and evaluate their diagnostic, prognostic, and clinical relevance. A systematic review of PubMed, Embase, Scopus, and Cochrane Library was conducted up to October 2025. Studies reporting CSF autoantibodies in systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS), neuromyelitis optica spectrum disorder (NMOSD), and rheumatoid arthritis (RA) with CNS involvement were included. Data on antibody type, clinical correlations, and prognostic significance were extracted and synthesized. Ten studies met the inclusion criteria. Anti-NR2 and anti-ribosomal P antibodies were associated with neuropsychiatric manifestations in SLE. Anti-SSA (Ro) indicated CNS involvement in pSS. CSF aquaporin-4 IgG correlated with active disease in NMOSD, while anti-cyclic citrullinated peptide antibodies were detected in RA-related meningitis. CSF autoantibodies reflected intrathecal immune activity and offered higher diagnostic specificity than serum measurements. CSF autoantibody profiling provides clinically relevant biomarkers for CNS involvement in rheumatologic disorders. Standardized, longitudinal studies are needed to develop predictive panels and guide personalized immunotherapy.