Neuropsychiatric Events in Systemic Lupus Erythematosus.
Hanly JG., Gordon C., Bae S-C., Romero-Diaz J., Sanchez-Guerrero J., Bernatsky S., Clarke AE., Wallace DJ., Isenberg DA., Rahman A., Merrill JT., Fortin PR., Gladman DD., Urowitz MB., Bruce IN., Petri M., Ginzler EM., Dooley MA., Ramsey-Goldman R., Manzi S., Jonsen A., Alarcón GS., van Vollenhoven RF., Aranow C., Mackay M., Ruiz-Irastorza G., Lim SS., Inanc M., Kalunian KC., Jacobsen S., Peschken CA., Kamen DL., Askanase A., Farewell V.
ObjectivesTo determine predictors for change in neuropsychiatric (NP) event status in a large, prospective, international, inception cohort of SLE patients METHODS: Upon enrollment and annually thereafter, NP events attributed to SLE and non-SLE causes and physician determined resolution were documented. Factors potentially associated with onset and resolution of NP events were determined by time-to-event analysis using a multistate modelling structure.ResultsNP events occurred in 955/1,827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. For SLE NP events multivariate analysis revealed positive associations with male sex, concurrent non-SLE NP events excluding headache, active SLE and corticosteroids. There was a negative association with Asian race/ethnicity, post-secondary education, and immunosuppressive or anti-malarial drugs. For non-SLE NP events, excluding headache, there was a positive association with concurrent SLE NP events and negative associations with African and Asian race/ethnicity. NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache that had comparable resolution rates. For SLE NP events, multivariate analysis revealed resolution was more common with Asian race/ethnicity and for central/focal NP events. For non-SLE NP events resolution was more common with African race/ethnicity and less common with older age at SLE diagnosis.ConclusionsIn a large and long-term study of the occurrence and resolution of NP events in SLE we identified subgroups with better and worse prognosis. The course of NP events differs greatly depending on their nature and attribution.