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Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

Hanly, John G.; Su, Li; Urowitz, Murray B.; Romero-Diaz, Juanita; Gordon, Caroline; Bae, Sang-Cheol; Bernatsky, Sasha; Clarke, Ann E.; Wallace, Daniel J. and Merrill, Joan T., et al. (2015) In Arthritis & Rheumatology 67(7). p.1837-1847
Abstract
ObjectiveTo examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). MethodsPatients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric 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 subscales, mental and physical component summary scores were collected. Time to event, linear and... (More)
ObjectiveTo examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). MethodsPatients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric 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 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. ResultsAmong the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean SD age of the patients was 35.1 +/- 13.3 years, disease duration was 5.6 +/- 4.8 months, and the length of followup was 4.7 +/- 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P0.01), and a lower risk was associated with Asian race/ethnicity (P=0.01) and treatment with immunosuppressive drugs (P=0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. ConclusionMood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies. (Less)
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published
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Arthritis & Rheumatology
volume
67
issue
7
pages
1837 - 1847
publisher
Wiley-Blackwell
external identifiers
  • wos:000357013500019
  • scopus:84933059999
ISSN
2326-5191
DOI
10.1002/art.39111
language
English
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yes
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ca077dbb-ba78-42c9-a804-d554950b0bf2 (old id 7790756)
date added to LUP
2015-09-01 16:08:00
date last changed
2017-11-05 04:06:28
@article{ca077dbb-ba78-42c9-a804-d554950b0bf2,
  abstract     = {ObjectiveTo examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). MethodsPatients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric 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 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. ResultsAmong the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean SD age of the patients was 35.1 +/- 13.3 years, disease duration was 5.6 +/- 4.8 months, and the length of followup was 4.7 +/- 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P0.01), and a lower risk was associated with Asian race/ethnicity (P=0.01) and treatment with immunosuppressive drugs (P=0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. ConclusionMood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.},
  author       = {Hanly, John G. and Su, Li and Urowitz, Murray B. and Romero-Diaz, Juanita and Gordon, Caroline and Bae, Sang-Cheol and Bernatsky, Sasha and Clarke, Ann E. and Wallace, Daniel J. and Merrill, Joan T. and Isenberg, David A. and Rahman, Anisur and Ginzler, Ellen M. and Petri, Michelle and Bruce, Ian N. and Dooley, M. A. and Fortin, Paul and Gladman, Dafna D. and Sanchez-Guerrero, Jorge and Steinsson, Kristjan and Ramsey-Goldman, Rosalind and Khamashta, Munther A. and Aranow, Cynthia and Alarcon, Graciela S. and Fessler, Barri J. and Manzi, Susan and Nived, Ola and Sturfelt, Gunnar and Zoma, Asad A. and van Vollenhoven, Ronald F. and Ramos-Casals, Manuel and Ruiz-Irastorza, Guillermo and Lim, S. Sam and Kalunian, Kenneth C. and Inanc, Murat and Kamen, Diane L. and Peschken, Christine A. and Jacobsen, Soren and Askanase, Anca and Theriault, Chris and Thompson, Kara and Farewell, Vernon},
  issn         = {2326-5191},
  language     = {eng},
  number       = {7},
  pages        = {1837--1847},
  publisher    = {Wiley-Blackwell},
  series       = {Arthritis & Rheumatology},
  title        = {Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study},
  url          = {http://dx.doi.org/10.1002/art.39111},
  volume       = {67},
  year         = {2015},
}