TY - JOUR
T1 - Psychosis in Systemic Lupus Erythematosus
T2 - Results From an International Inception Cohort Study
AU - Hanly, John G
AU - Li, Qiuju
AU - Su, Li
AU - Urowitz, Murray B
AU - Gordon, Caroline
AU - Bae, Sang-Cheol
AU - Romero-Diaz, Juanita
AU - Sanchez-Guerrero, Jorge
AU - Bernatsky, Sasha
AU - Clarke, Ann E
AU - Wallace, Daniel J
AU - Isenberg, David A
AU - Rahman, Anisur
AU - Merrill, Joan T
AU - Fortin, Paul R
AU - Gladman, Dafna D
AU - Bruce, Ian N
AU - Petri, Michelle
AU - Ginzler, Ellen M
AU - Dooley, M A
AU - Steinsson, Kristjan
AU - Ramsey-Goldman, Rosalind
AU - Zoma, Asad A
AU - Manzi, Susan
AU - Nived, Ola
AU - Jonsen, Andreas
AU - Khamashta, Munther A
AU - Alarcón, Graciela S
AU - van Vollenhoven, Ronald F
AU - Aranow, Cynthia
AU - Mackay, Meggan
AU - Ruiz-Irastorza, Guillermo
AU - Ramos-Casals, Manuel
AU - Lim, S Sam
AU - Inanc, Murat
AU - Kalunian, Kenneth C
AU - Jacobsen, Søren
AU - Peschken, Christine A
AU - Kamen, Diane L
AU - Askanase, Anca
AU - Theriault, Chris
AU - Farewell, Vernon
PY - 2019
Y1 - 2019
N2 - OBJECTIVE: To determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (SLE), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short- and long-term outcomes as assessed by physicians and patients.METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (SF-36) were recorded. Time to event and linear regressions were used as appropriate.RESULTS: Of 1,826 SLE patients, 88.8% were female and 48.8% were Caucasian. The mean ± SD age was 35.1 ± 13.3 years, the mean ± SD disease duration was 5.6 ± 4.2 months, and the mean ± SD follow-up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [HRs] and 95% confidence intervals [95% CIs]) with lupus psychosis were previous SLE NP events (HR 3.59 [95% CI 1.16-11.14]), male sex (HR 3.0 [95% CI 1.20-7.50]), younger age at SLE diagnosis (per 10 years) (HR 1.45 [95% CI 1.01-2.07]), and African ancestry (HR 4.59 [95% CI 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 outlooks are good for most patients, although careful follow-up is required.
AB - OBJECTIVE: To determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (SLE), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short- and long-term outcomes as assessed by physicians and patients.METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (SF-36) were recorded. Time to event and linear regressions were used as appropriate.RESULTS: Of 1,826 SLE patients, 88.8% were female and 48.8% were Caucasian. The mean ± SD age was 35.1 ± 13.3 years, the mean ± SD disease duration was 5.6 ± 4.2 months, and the mean ± SD follow-up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [HRs] and 95% confidence intervals [95% CIs]) with lupus psychosis were previous SLE NP events (HR 3.59 [95% CI 1.16-11.14]), male sex (HR 3.0 [95% CI 1.20-7.50]), younger age at SLE diagnosis (per 10 years) (HR 1.45 [95% CI 1.01-2.07]), and African ancestry (HR 4.59 [95% CI 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 outlooks are good for most patients, although careful follow-up is required.
KW - Adult
KW - Age Factors
KW - Antibodies, Anticardiolipin/immunology
KW - Autoantibodies/immunology
KW - Cohort Studies
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Linear Models
KW - Lupus Coagulation Inhibitor/immunology
KW - Lupus Erythematosus, Systemic/epidemiology
KW - Lupus Vasculitis, Central Nervous System/epidemiology
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Psychotic Disorders/epidemiology
KW - Receptors, N-Methyl-D-Aspartate/immunology
KW - Sex Factors
KW - Young Adult
KW - beta 2-Glycoprotein I/immunology
U2 - 10.1002/art.40764
DO - 10.1002/art.40764
M3 - Journal article
C2 - 30375754
SN - 2326-5205
VL - 71
SP - 281
EP - 289
JO - Arthritis & Rheumatology
JF - Arthritis & Rheumatology
IS - 2
ER -