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Headache in Systemic Lupus Erythematosus Results From a Prospective, International Inception Cohort Study

Hanly, John G.; Urowitz, Murray B.; O'Keeffe, Aidan G.; Gordon, Caroline; Bae, Sang-Cheol; Sanchez-Guerrero, Jorge; Romero-Diaz, Juanita; Clarke, Ann E.; Bernatsky, Sasha and Wallace, Daniel J., et al. (2013) In Arthritis and Rheumatism 65(11). p.2887-2897
Abstract
ObjectiveTo examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). MethodsA disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression... (More)
ObjectiveTo examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). MethodsA disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations. ResultsAmong the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean SD age was 34.6 +/- 13.4 years, duration of disease was 5.6 +/- 5.2 months, and length of followup was 3.8 +/- 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean +/- SD 42.5 +/- 12.2 versus 47.8 +/- 11.3; P < 0.001), and similar differences in physical component scores were seen (38.0 +/- 11.0 in those with headache versus 42.6 +/- 11.4 in those without headache; P < 0.001). In 56.1% of patients, the headaches resolved over followup. ConclusionHeadache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies. (Less)
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published
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Arthritis and Rheumatism
volume
65
issue
11
pages
2887 - 2897
publisher
John Wiley & Sons
external identifiers
  • wos:000326138200018
  • scopus:84886776750
ISSN
1529-0131
DOI
10.1002/art.38106
language
English
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yes
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0eef268f-78ad-4421-a0dc-3554f7ed8179 (old id 4212543)
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2014-01-03 10:47:39
date last changed
2019-07-14 03:11:50
@article{0eef268f-78ad-4421-a0dc-3554f7ed8179,
  abstract     = {ObjectiveTo examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). MethodsA disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations. ResultsAmong the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean SD age was 34.6 +/- 13.4 years, duration of disease was 5.6 +/- 5.2 months, and length of followup was 3.8 +/- 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean +/- SD 42.5 +/- 12.2 versus 47.8 +/- 11.3; P &lt; 0.001), and similar differences in physical component scores were seen (38.0 +/- 11.0 in those with headache versus 42.6 +/- 11.4 in those without headache; P &lt; 0.001). In 56.1% of patients, the headaches resolved over followup. ConclusionHeadache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies.},
  author       = {Hanly, John G. and Urowitz, Murray B. and O'Keeffe, Aidan G. and Gordon, Caroline and Bae, Sang-Cheol and Sanchez-Guerrero, Jorge and Romero-Diaz, Juanita and Clarke, Ann E. and Bernatsky, Sasha and Wallace, Daniel J. and Ginzler, Ellen M. and Isenberg, David A. and Rahman, Anisur and Merrill, Joan T. and Petri, Michelle and Fortin, Paul R. and Gladman, Dafna D. and Fessler, Barri J. and Alarcon, Graciela S. and Bruce, Ian N. and Dooley, Mary Anne and Steinsson, Kristjan and Khamashta, Munther A. and Ramsey-Goldman, Rosalind and Manzi, Susan and Sturfelt, Gunnar and Nived, Ola and Zoma, Asad A. and van Vollenhoven, Ronald F. and Ramos-Casals, Manuel and Aranow, Cynthia and Mackay, Meggan and Ruiz-Irastorza, Guillermo and Kalunian, Kenneth C. and Lim, S. Sam and Inanc, Murat and Kamen, Diane L. and Peschken, Christine A. and Jacobsen, Soren and Theriault, Chris and Thompson, Kara and Farewell, Vernon},
  issn         = {1529-0131},
  language     = {eng},
  number       = {11},
  pages        = {2887--2897},
  publisher    = {John Wiley & Sons},
  series       = {Arthritis and Rheumatism},
  title        = {Headache in Systemic Lupus Erythematosus Results From a Prospective, International Inception Cohort Study},
  url          = {http://dx.doi.org/10.1002/art.38106},
  volume       = {65},
  year         = {2013},
}