Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2010 Mar;69(3):529-35.
doi: 10.1136/ard.2008.106351. Epub 2009 Apr 8.

Prospective analysis of neuropsychiatric events in an international disease inception cohort of patients with systemic lupus erythematosus

J G Hanly  1 , M B Urowitz, L Su, S C Bae, C Gordon, D J Wallace, A Clarke, S Bernatsky, D Isenberg, A Rahman, G S Alarcón, D D Gladman, P R Fortin, J Sanchez-Guerrero, J Romero-Diaz, J T Merrill, E Ginzler, I N Bruce, K Steinsson, M Khamashta, M Petri, S Manzi, M A Dooley, R Ramsey-Goldman, R Van Vollenhoven, O Nived, G Sturfelt, C Aranow, K Kalunian, M Ramos-Casals, A Zoma, J Douglas, K Thompson, V Farewell; Systemic Lupus International Collaborating Clinics (SLICC)
Affiliations
Multicenter Study

Prospective analysis of neuropsychiatric events in an international disease inception cohort of patients with systemic lupus erythematosus

J G Hanly et al. Ann Rheum Dis. 2010 Mar.

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 patients with systemic lupus erythematosus (SLE).

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 American College of Rheumatology 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: 1206 patients (89.6% female) with a mean (+/-SD) age of 34.5+/-13.2 years were included in the study. 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 > or =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 patients with SLE are of variable 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The cumulative frequency of patients with NP events at enrollment and at subsequent study assessments. The percentage of patients with NP events is shown at each time point for all NP events regardless of attribution (all NP), NP events attributed to non-SLE causes (non-SLE NP), NP events attributed to SLE as per attribution model B (SLE NP (B)) and NP events attributed to SLE as per attribution model A (SLE NP (A)).
Figure 2
Figure 2
The frequency of NP events at enrollment and at subsequent study assessments characterized as new, recurring or ongoing from a previous assessment. At each assessment the status of the NP events into resolved or unresolved is shown. Summary data is shown for NP events regardless of attribution (all NP events), NP events attributed to SLE as per attribution model A (SLE NP (A)), NP events attributed to SLE as per attribution model B (SLE NP (B)) and NP events attributed to non-SLE causes (non-SLE NP).
Figure 3
Figure 3
The outcome of NP events over the duration of the study. Events are clustered into all NP events regardless of attribution (all NP events), NP events attributed to SLE as per attribution model A (SLE NP events (model A)), NP events attributed to SLE as per attribution model B (SLE NP events (model B)) and NP events attributed to non-SLE causes (non-SLE NP events). Within each panel the outcome of the events is scored as much worse, worse, no change, improved, much improved and resolved at assessments 1 through 4 compared to the onset of the event.
Figure 4
Figure 4
Mean MCS and PCS of the SF-36 over the period of study in patients with no NP events (NP negative), NP events attributed to non-SLE causes (non-SLE NP) and NP events attributed to SLE as per attribution model A or B (SLE NP A or B) at each of the study assessments. (See appendix #3).
Figure 4
Figure 4
Mean MCS and PCS of the SF-36 over the period of study in patients with no NP events (NP negative), NP events attributed to non-SLE causes (non-SLE NP) and NP events attributed to SLE as per attribution model A or B (SLE NP A or B) at each of the study assessments. (See appendix #3).
See this image and copyright information in PMC

References

    1. Ainiala H, Hietaharju A, Loukkola J, Peltola J, Korpela M, Metsanoja R, et al. Validity of the new American College of Rheumatology criteria for neuropsychiatric lupus syndromes: a population-based evaluation. Arthritis Rheum. 2001;45(5):419–23. - PubMed
    1. Brey RL, Holliday SL, Saklad AR, Navarrete MG, Hermosillo-Romo D, Stallworth CL, et al. Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology. 2002;58(8):1214–20. - PubMed
    1. Hanly JG, McCurdy G, Fougere L, Douglas JA, Thompson K. Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance. J Rheumatol. 2004;31(11):2156–62. - PubMed
    1. Sanna G, Bertolaccini ML, Cuadrado MJ, Laing H, Mathieu A, Hughes GR. Neuropsychiatric manifestations in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies. J Rheumatol. 2003;30(5):985–92. - PubMed
    1. Sibbitt WL, Jr, Brandt JR, Johnson CR, Maldonado ME, Patel SR, Ford CC, et al. The incidence and prevalence of neuropsychiatric syndromes in pediatric onset systemic lupus erythematosus. J Rheumatol. 2002;29(7):1536–42. - PubMed

Publication types