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Journal article
Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach
Annals of the rheumatic diseases, v 79(3), pp 356-362
01 Mar 2020
PMID: 31915121
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Abstract
ObjectivesUsing a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients.MethodsAnnual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states.ResultsNP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001).ConclusionsNP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.
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Details
- Title
- Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach
- Creators
- John G Hanly - Queen Elizabeth II Health Sciences CentreMurray B Urowitz - University of TorontoCaroline Gordon - University of BirminghamSang-Cheol Bae - Hanyang University Seoul HospitalJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránJorge Sanchez-Guerrero - University of TorontoSasha Bernatsky - McGill UniversityAnn E Clarke - University of CalgaryDaniel J Wallace - Cedars-Sinai Medical CenterDavid A Isenberg - British Society for RheumatologyAnisur Rahman - University College LondonJoan T Merrill - Oklahoma Medical Research FoundationPaul R Fortin - Université LavalDafna D Gladman - University of TorontoIan N Bruce - Manchester Academic Health Science CentreMichelle Petri - Johns Hopkins MedicineEllen M Ginzler - SUNY Downstate Health Sciences UniversityMary Anne Dooley - University of North Carolina at Chapel HillRosalind Ramsey-Goldman - Northwestern UniversitySusan Manzi - Allegheny Health NetworkAndreas Jönsen - Lund UniversityGraciela S Alarcón - University of Alabama at BirminghamRonald F van Vollenhoven - Department of Rheumatology and Clinical Immunology, University Medical Centres, Amsterdam, The NetherlandsCynthia Aranow - Feinstein Institute for Medical ResearchMeggan Mackay - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - University of the Basque CountrySam Lim - Emory UniversityMurat Inanc - Istanbul UniversityKenneth C Kalunian - University of California, San DiegoSøren Jacobsen - Copenhagen University HospitalChristine A Peschken - University of ManitobaDiane L Kamen - Medical University of South CarolinaAnca Askanase - New York University Langone Orthopedic HospitalVernon Farewell - University of Cambridge
- Publication Details
- Annals of the rheumatic diseases, v 79(3), pp 356-362
- Publisher
- British Medical Journal (BMJ)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000519264600018
- Scopus ID
- 2-s2.0-85077755832
- Other Identifier
- 991021934000304721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology