Proposed pathogenesis of neuropsychiatric lupus. Auto-antibodies enter the brain causing neuronal damage, including impaired neuroplasticity and synaptic transition. In order to reach the brain, the blood–brain barrier must be transiently breached by external (for example, infection) or internal (for example, metabolic derangement, cytokines) triggers. Vascular injury can be antibody mediated by aPL antibodies or via accelerated classical atherosclerosis. aPL, Anti-phospholipid antibodies; BBB, Blood brain barrier; RiboP, Ribosomal-P; NMDAR, NMDA receptor. The authors are responsible for designing the figure above.