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Neuropsychiatric Events in Systemic Lupus Erythematosus : Predictors of Occurrence and Resolution in a Longitudinal Analysis of an International Inception Cohort

Hanly, John G. ; Gordon, Caroline ; Bae, Sang Cheol ; Romero-Diaz, Juanita ; Sanchez-Guerrero, Jorge ; Bernatsky, Sasha ; Clarke, Ann E. ; Wallace, Daniel J. ; Isenberg, David A. and Rahman, Anisur , et al. (2021) In Arthritis and Rheumatology 73(12). p.2293-2302
Abstract

Objective: To determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE). 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 the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure. Results: NP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P = 0.028),... (More)

Objective: To determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE). 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 the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure. Results: NP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P = 0.028), concurrent non-SLE NP events excluding headache (P < 0.001), active SLE (P = 0.012), and glucocorticoid use (P = 0.008). There was a negative association with Asian race (P = 0.002), postsecondary education (P = 0.001), and treatment with immunosuppressive drugs (P = 0.019) or antimalarial drugs (P = 0.056). For non-SLE NP events excluding headache, there was a positive association with concurrent SLE NP events (P < 0.001) and a negative association with African race (P = 0.012) and Asian race (P < 0.001). NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache, which had comparable resolution rates. For SLE NP events, multivariate analysis revealed that resolution was more common in patients of Asian race (P = 0.006) and for central/focal NP events (P < 0.001). For non-SLE NP events, resolution was more common in patients of African race (P = 0.017) and less common in patients who were older at SLE diagnosis (P < 0.001). Conclusion: In 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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Arthritis and Rheumatology
volume
73
issue
12
pages
2293 - 2302
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:34042329
  • scopus:85118217441
ISSN
2326-5191
DOI
10.1002/art.41876
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021, American College of Rheumatology
id
11f2c620-a83e-4e4f-936a-5b333457eb01
date added to LUP
2021-11-24 14:30:06
date last changed
2022-08-04 20:47:41
@article{11f2c620-a83e-4e4f-936a-5b333457eb01,
  abstract     = {{<p>Objective: To determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE). 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 the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure. Results: NP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P = 0.028), concurrent non-SLE NP events excluding headache (P &lt; 0.001), active SLE (P = 0.012), and glucocorticoid use (P = 0.008). There was a negative association with Asian race (P = 0.002), postsecondary education (P = 0.001), and treatment with immunosuppressive drugs (P = 0.019) or antimalarial drugs (P = 0.056). For non-SLE NP events excluding headache, there was a positive association with concurrent SLE NP events (P &lt; 0.001) and a negative association with African race (P = 0.012) and Asian race (P &lt; 0.001). NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache, which had comparable resolution rates. For SLE NP events, multivariate analysis revealed that resolution was more common in patients of Asian race (P = 0.006) and for central/focal NP events (P &lt; 0.001). For non-SLE NP events, resolution was more common in patients of African race (P = 0.017) and less common in patients who were older at SLE diagnosis (P &lt; 0.001). Conclusion: In 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.</p>}},
  author       = {{Hanly, John G. and Gordon, Caroline and Bae, Sang Cheol and Romero-Diaz, Juanita and Sanchez-Guerrero, Jorge and Bernatsky, Sasha and Clarke, Ann E. and Wallace, Daniel J. and Isenberg, David A. and Rahman, Anisur and Merrill, Joan T and Fortin, Paul R. and Gladman, Dafna D. and Urowitz, Murray B. and Bruce, Ian N. and Petri, Michelle and Ginzler, Ellen M. and Dooley, M. A. and Ramsey-Goldman, Rosalind and Manzi, Susan and Jonsen, Andreas and Alarcón, Graciela S. and van Vollenhoven, Ronald F. and Aranow, Cynthia and Mackay, Meggan and Ruiz-Irastorza, Guillermo and Lim, S. Sam and Inanc, Murat and Kalunian, Kenneth C. and Jacobsen, Soren and Peschken, Christine A and Kamen, Diane L. and Askanase, Anca and Farewell, Vernon}},
  issn         = {{2326-5191}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{2293--2302}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Arthritis and Rheumatology}},
  title        = {{Neuropsychiatric Events in Systemic Lupus Erythematosus : Predictors of Occurrence and Resolution in a Longitudinal Analysis of an International Inception Cohort}},
  url          = {{http://dx.doi.org/10.1002/art.41876}},
  doi          = {{10.1002/art.41876}},
  volume       = {{73}},
  year         = {{2021}},
}