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.

Hanly JG, Fisk JD, McCurdy G, Fougere L, JA.

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/pubmed/16078320

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