RESEARCH - Prospective analysis of neuropsychiatric events in an international disease inception cohort of SLE patients

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Ann Rheum Dis. Published Online First: 8 April 2009.

doi:10.1136/ard.2008.106351

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Extended Report

Prospective analysis of neuropsychiatric events in an international

disease inception cohort of SLE patients

J G Hanly 1*, M B Urowitz 2, L Su 3, S C Bae 4, C Gordon 5, D J

Wallace 6, A e 7, S Bernatsky 7, D Isenberg 8, A Anisur 8, G S

Alarcon 9, D D Gladman 10, P R Fortin 10, J -Guerrero 11, J

Romero- 11, J T Merrill 12, E Ginzler 13, I N Bruce 14, K

Steinsson 15, M Khamashta 16, M Petri 17, S Manzi 18, MA Dooley 19, R

Ramsey-Goldman 20, R van Vollenhoven 21, O Nived 22, G Sturfelt 22, C

Aranow 23, K Kalunian 24, M Ramos-Casals 25, A Zoma 26, J 1, K

1 and V Farewell 3

1 QEII Health Sciences Centre and Dalhousie University, Canada

2 Centre for Prognosis Studies in the Rheumatic Diseases, Toronto

Western Hospital, Canada

3 Institute of Public Health, University Forvie Site, United Kingdom

4 The Hospital for Rheumatic Diseases and Hanyang University Medical

Center, Korea, Democratic People's Republic of

5 College of Medical and Dental Sciences, University of Birmingham,

United Kingdom

6 Cedars-Sinai/ Geffen School of Medicine at UCLA, United States

7 Montreal General Hospital, McGill University Health Centre, Canada

8 Centre for Rheumatology Research, University College, United Kingdom

9 University of Alabama at Birmingham, United States

10 Toronto Western Hospital and University of Toronto, Canada

11 Instituto Nacional de Ciencias Medicas y Nutricion, Mexico

12 Oklahoma Medical Research Foundation, United States

13 SUNY Downstate Medical Center, United States

14 The Kellgren Centre for Rheumatology, University of Manchester,

United Kingdom

15 Landspitali University Hospital, Iceland

16 the Rayne Institute, St Hospital, King's College London

School of Medicine, United Kingdom

17 s Hopkins University, United States

18 University of Pittsburgh School of Medicine, United States

19 University of North Carolina, United States

20 Northwestern University and Feinberg School of Medicine, United States

21 Karolinska University, Sweden

22 University Hospital Lund, Sweden

23 Columbia University Medical Centre, United States

24 UCSD School of Medicine, United States

25 Servicio Enfermedades Autoimmunes Hospital Clinico y Provincial, Spain

26 Lanarkshire Centre for Rheumatology, Hairmyres Hospital, United Kingdom

Abstract

Objectives: To determine the frequency, accrual, attribution and

outcome of neuropsychiatric (NP) events and impact on quality of life

over 3 years in a large inception cohort of SLE patients.

Methods: The study was conducted by the Systemic Lupus International

Collaborating Clinics. Patients were enrolled within 15 months of SLE

diagnosis. NP events were identified using the ACR case definitions

and decision rules were derived to determine the proportion of NP

disease attributable to SLE. The outcome of NP events was recorded and

patient perceived impact determined by the SF-36.

Results: There were 1206 patients (89.6% female) with a mean (±SD) age

of 34.5±13.2 years. The mean disease duration at enrollment was

5.4±4.2 months. Over a mean follow-up of 1.9±1.2 years 486/1206

(40.3%) patients had 1 NP events which were attributed to SLE in

13.0%-23.6% of patients using two a priori decision rules. The

frequency of individual NP events varied from 47.1% (headache) to 0%

(myasthenia gravis). The outcome was significantly better for those NP

events attributed to SLE especially if they occurred within 1.5 years

of the diagnosis of SLE. Patients with NP events, regardless of

attribution, had significantly lower summary scores for both mental

and physical health over the study.

Conclusions: NP events in SLE patients are variable in frequency, most

commonly present early in the disease course and adversely impact

patients¡ quality of life over time. Events attributed to non-SLE

causes are more common than those due to SLE, although the latter have

a more favourable outcome.

http://ard.bmj.com/cgi/content/abstract/ard.2008.106351v1?papetoc

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