RESEARCH - Neuropsychiatric syndromes in patients with SLE and RA

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J Rheumatol. 2005 Aug;32(8):1459-6.

Neuropsychiatric syndromes in patients with systemic lupus erythematosus and

rheumatoid arthritis.

Division of Rheumatology, Department of Medicine, Queen II Health

Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada.

OBJECTIVE: The cause of neurologic (N) and psychiatric (P) syndromes in

patients with systemic lupus erythematosus (SLE) is mutifactorial and

includes primary immunopathogenic mechanisms, nonspecific sequelae of

chronic disease, and concurrent illnesses. We compared the prevalence,

diversity, and clinical significance of NP syndromes in patients with SLE

and rheumatoid arthritis (RA). METHODS: Fifty-three patients with SLE were

matched by age and sex to 53 patients with RA attending ambulatory clinics

in a single academic medical center. All fulfilled the American College of

Rheumatology (ACR) classification criteria for either SLE or RA. Cumulative

NP manifestations were determined using the ACR nomenclature and case

definitions for 19 NP syndromes. Depression and anxiety were measured by the

Hospital Anxiety and Depression Scales (HADS) and symptoms of cognitive

dysfunction were assessed by the Cognitive Symptoms Inventory (CSI). Health

related quality of life (HRQOL) was evaluated by the SF-36 and fatigue by a

10 point Likert scale. RESULTS: The patients were well matched with regard

to age, sex, disease duration, and years of education. There were no

significant differences in self-reported HRQOL, fatigue, anxiety,

depression, and cognitive symptoms between the 2 groups. The proportion of

patients with cumulative NP events was higher in RA than in SLE patients

(47% vs 28%; p = 0.045), and of these the occurrence of multiple NP events

in individual patients was comparable in both groups (SLE 53%; RA 48%; p =

0.75). Fifty-five percent and 66% of NP events occurred prior to the

diagnosis of SLE and RA, respectively. NP events common to both SLE and RA

patients were headaches, mood disorders, acute confusional states, anxiety,

cerebrovascular disease, and cognitive dysfunction. Seizures and

demyelinating syndrome occurred only in SLE patients, but were rare.

Depression scores (HADS) were significantly higher in SLE patients with a

history of cumulative NP events compared to RA patients with NP events (p =

0.02). Similarly, symptoms of cognitive dysfunction (CSI) were more common

in SLE patients with a history of NP manifestations (p = 0.02). However,

there were no significant differences in SF-36 subscale or fatigue scores

between SLE and RA patients with cumulative NP events.

CONCLUSION: NP syndromes, regardless of etiology, are common in both SLE and

RA patients. SLE patients with NP syndromes report more symptoms of

depression and cognitive dysfunction compared to RA patients with NP

syndromes, but do not report significantly poorer HRQOL. These results

emphasize the presence of non-disease-specific causes of NP manifestations

in SLE patients, which should be acknowledged in future studies of

pathogenesis and treatment.

PMID: 16078320

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus & db=pubmed & cmd=R\

etrieve & dopt=abstractplus & list_uids=16078320

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