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Peripheral Nervous System Disease in Systemic Lupus Erythematosus : Results From an International Inception Cohort Study

Hanly, John G. ; Li, Qiuju ; Su, Li ; Urowitz, Murray B. ; Gordon, Caroline ; Bae, Sang Cheol ; Romero-Diaz, Juanita ; Sanchez-Guerrero, Jorge ; Bernatsky, Sasha and Clarke, Ann E. , et al. (2020) In Arthritis and Rheumatology 72(1). p.67-77
Abstract

Objective: To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. 

Methods: Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. 

Results: Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up... (More)

Objective: To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. 

Methods: Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. 

Results: Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. 

Conclusion: PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.

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Contribution to journal
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published
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Arthritis and Rheumatology
volume
72
issue
1
pages
67 - 77
publisher
John Wiley & Sons
external identifiers
  • pmid:31390162
  • scopus:85075747200
ISSN
2326-5191
DOI
10.1002/art.41070
language
English
LU publication?
yes
id
4e190749-96bf-4aa9-87e2-b3057b0250c9
date added to LUP
2019-12-13 13:42:46
date last changed
2020-01-26 05:45:14
@article{4e190749-96bf-4aa9-87e2-b3057b0250c9,
  abstract     = {<p>Objective: To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. </p><p>Methods: Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. </p><p>Results: Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. </p><p>Conclusion: PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.</p>},
  author       = {Hanly, John G. and Li, Qiuju and Su, Li and Urowitz, Murray B. 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 Bruce, Ian N. and Petri, Michelle and Ginzler, Ellen M. and Dooley, M A and Steinsson, Kristjan and Ramsey-Goldman, Rosalind and Zoma, Asad A. and Manzi, Susan and Nived, Ola and Jonsen, Andreas and Khamashta, Munther A. and Alarcón, Graciela S. and Svenungsson, Elisabet and van Vollenhoven, Ronald F. and Aranow, Cynthia and Mackay, Meggan and Ruiz-Irastorza, Guillermo and Ramos-Casals, Manuel and Lim, Sung Sam and Inanc, Murat and Kalunian, Kenneth C. and Jacobsen, Soren and Peschken, Christine A. and Kamen, Diane L. and Askanase, Anca and Theriault, Chris and Farewell, Vernon},
  issn         = {2326-5191},
  language     = {eng},
  number       = {1},
  pages        = {67--77},
  publisher    = {John Wiley & Sons},
  series       = {Arthritis and Rheumatology},
  title        = {Peripheral Nervous System Disease in Systemic Lupus Erythematosus : Results From an International Inception Cohort Study},
  url          = {http://dx.doi.org/10.1002/art.41070},
  doi          = {10.1002/art.41070},
  volume       = {72},
  year         = {2020},
}