Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: An international inception cohort study

Abstract

Objective. To describe the prevalence, characteristics, attribution, and clinical significance of neuropsychiatric (NP) events in an international inception cohort of systemic lupus erythematosus (SLE) patients.Methods. The study was conducted by the Systemic Lupus International Collaborating Clinics (SLICC). Patients were enrolled within 15 months of fulfilling the American College of Rheumatology (ACR) SLE classification criteria. All NP events within a predefined enrollment window were identified using the ACR case definitions of 19 NP syndromes. Decision rules were derived to determine the proportion of NP disease attributable to SLE. Clinical significance was determined using the Short Form 36 (SF-36) Health Survey and the SLICC/ACR Damage Index (SDI).Results. A total of 572 patients (88% female) were recruited, with a mean ؎ SD age of 35 ؎ 14 years. The mean ؎ SD disease duration was 5.2 ؎ 4.2 months. Within the enrollment window, 158 of 572 patients (28%) had at least 1 NP event. In total, there were 242 NP events that encompassed 15 of 19 NP syndromes. The proportion of NP events attributed to SLE varied from 19% to 38% using alternate attribution models and occurred in 6.1-11.7% of patients. Those with NP events, regardless of attribution, had lower scores on the SF-36 and higher SDI scores compared with patients with no NP events.Conclusion. Twenty-eight percent of SLE patients experienced at least 1 NP event around the time of diagnosis of SLE, of which only a minority were attributed to SLE. Regardless of attribution, the occurrence of NP events was associated with reduced quality of life and increased organ damage.Nervous system involvement as part of systemic lupus erythematosus (SLE) is well recognized, although the prevalence is highly variable among studies (1-7). A wide range of neuropsychiatric (NP) manifestations have been described, which span common features such Dr. Hanly

Autoantibodies and neuropsychiatric events at the time of systemic lupus erythematosus diagnosis: Results from an international inception cohort study

“…The study was conducted by members of the Systemic Lupus International Collaborating Clinics (SLICC) (23), which consists of 30 investigators at 27 international academic medical centers. Data were collected prospectively on patients presenting with a new diagnosis of SLE as previously described (7). The study protocol was approved by the Capital Health Research Ethics Board (Halifax, Nova Scotia, Canada) and by each participating center's own institutional research ethics review board.…”

“…The reported frequency of neuropsychiatric (NP) disease among patients with SLE, classified using the American College of Rheumatology (ACR) case definitions (1), varies from 37% to 95% (2)(3)(4)(5)(6). The clinical significance of NP events is highlighted by their negative impact on health-related quality of life (4,7) and increased mortality among patients with NPSLE (8). Determining the correct attribution of NP events is a significant challenge when managing nervous system disease in individual SLE patients and is a critical factor in selecting the correct treatment and determining prognosis.…”

TULUP (TUnisian LUPus): a multicentric study of systemic lupus erythematosus in Tunisia

“…A wide range of neuropsychiatric manifestations have been described, from common features such as headache and seizure, to rarer events such as psychosis. 31 Frequencies of neuropsychiatric manifestations range from 9% to 68% (Table 6). In our study 37% of patients had neuropsychiatric involvement.…”

Actualización en lupus neuro-psiquiátrico con énfasis en déficit cognitivo

“…Según Hanly et al, las manifestaciones NP atribuibles a LES como enfermedad autoinmune serían sólo de 31% 7,18,19 . En un extremo se encuentran las convulsiones y la psicosis lúpica, que son manifestaciones claramente atribuibles al LES, tanto que forman parte de los criterios de clasificación diagnóstica de LES del ACR 20 , y si bien son poco frecuentes, se suelen presentar con enfermedad activa 21,22 .…”