Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study
Authors
Hanly, JG
Li, Q
Su, L
Urowitz, MB
Gordon, C
Bae, SC
Romero-Diaz, J
Sanchez-Guerrero, J
Bernatsky, S
Clarke, AE
Wallace, DJ
Isenberg, DA
Rahman, A
Merrill, JT
Fortin, PR
Gladman, DD
Bruce, IN
Ginzler, E
Dooley, MA
Steinsson, K
Ramsey-Goldman, R
Zoma, AA
Manzi, S
Nived, O
Jonsen, A
Khamashta, MA
Alarcón, GS
van Vollenhoven, RF
Aranow, C
Mackay, M
Ruiz-Irastorza, G
Ramos-Casals, M
Lim, SS
Inanc, M
Kalunian, KC
Jacobsen, S
Peschken, CA
Kamen, DL
Askanase, A
Theriault, C
Farewell, V
Publication Date
2019Journal Title
Arthritis and Rheumatology
ISSN
2326-5191
Publisher
Wiley
Volume
71
Issue
2
Pages
281-289
Type
Article
Metadata
Show full item recordCitation
Hanly, J., Li, Q., Su, L., Urowitz, M., Gordon, C., Bae, S., Romero-Diaz, J., et al. (2019). Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis and Rheumatology, 71 (2), 281-289. https://doi.org/10.1002/art.40764
Abstract
Objectives: To determine, in a multi-ethnic/racial, prospective SLE inception cohort, the frequency, attribution, clinical and autoantibody associations with lupus psychosis and the short and long-term outcome as assessed by physicians and patients. Methods: Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. SLE disease activity 2000, SLICC/ACR damage index and SF-36 scores were collected. Time to event and linear regressions were used as appropriate. Results: Of 1,826 SLE patients, 88.8% were female, 48.8% Caucasian. The meanSD age was 35.1±13.3 years, disease duration 5.64.2 months and follow-up 7.44.5 years. There were 31 psychotic events in 28/1,826 (1.53%) patients and most [(26/28; 93%)] had a single event. In the majority of patients [20/25; (80%)] and events [28/31; (90%)] psychosis was attributed to SLE, usually within 3 years of SLE diagnosis. Positive associations [hazard ratio and 95% confidence interval [HR (95%CI)] with lupus psychosis were prior SLE NP events [3.59, (1.16, 11.14), male sex [3.0, (1.20, 7.50)], younger age at SLE diagnosis [(per 10 years younger), 1.45 (1.01, 2.07)] and African ancestry [4.59 (1.79, 11.76)]. By physician assessment most psychotic events resolved by the second annual visit following onset, in parallel with an improvement in patient reported SF-36 summary and subscale scores. Conclusion: Psychosis is an infrequent manifestation of NPSLE. Generally, it occurs early after SLE onset and has a significant negative impact on health status. As determined by patient and physician report, the short and long term outlook is good for most patients, though careful follow-up is required.
Keywords
Autoimmune Disease, Lupus, Mental Health, Clinical Research, 6 Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Inflammatory and immune system, Adult, Age Factors, Antibodies, Anticardiolipin, Autoantibodies, Cohort Studies, Female, Humans, Kaplan-Meier Estimate, Linear Models, Lupus Coagulation Inhibitor, Lupus Erythematosus, Systemic, Lupus Vasculitis, Central Nervous System, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Psychotic Disorders, Receptors, N-Methyl-D-Aspartate, Sex Factors, Young Adult, beta 2-Glycoprotein I
Sponsorship
MRC (unknown)
MRC (unknown)
Identifiers
External DOI: https://doi.org/10.1002/art.40764
This record's URL: https://www.repository.cam.ac.uk/handle/1810/286281
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