Journal article
Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study
Arthritis & rheumatology (Hoboken, N.J.), v 71(2), pp 281-289
Feb 2019
PMID: 30375754
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
To determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (SLE), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short- and long-term outcomes as assessed by physicians and patients.
Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (SF-36) were recorded. Time to event and linear regressions were used as appropriate.
Of 1,826 SLE patients, 88.8% were female and 48.8% were Caucasian. The mean ± SD age was 35.1 ± 13.3 years, the mean ± SD disease duration was 5.6 ± 4.2 months, and the mean ± SD follow-up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [HRs] and 95% confidence intervals [95% CIs]) with lupus psychosis were previous SLE NP events (HR 3.59 [95% CI 1.16-11.14]), male sex (HR 3.0 [95% CI 1.20-7.50]), younger age at SLE diagnosis (per 10 years) (HR 1.45 [95% CI 1.01-2.07]), and African ancestry (HR 4.59 [95% CI 1.79-11.76]). By physician assessment, most psychotic events resolved by the second annual visit following onset, in parallel with an improvement in patient-reported SF-36 summary and subscale scores.
Psychosis is an infrequent manifestation of NPSLE. Generally, it occurs early after SLE onset and has a significant negative impact on health status. As determined by patient and physician report, the short- and long-term outlooks are good for most patients, although careful follow-up is required.
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Details
- Title
- Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study
- Creators
- John G Hanly - Queen Elizabeth II Health Sciences CentreQiuju Li - University of CambridgeLi Su - University of CambridgeMurray B Urowitz - Toronto Western HospitalCaroline Gordon - University of BirminghamSang-Cheol Bae - Hanyang University Seoul HospitalJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránJorge Sanchez-Guerrero - Toronto Western HospitalSasha Bernatsky - McGill UniversityAnn E Clarke - University of CalgaryDaniel J Wallace - Cedars-Sinai Medical CenterDavid A Isenberg - University College LondonAnisur Rahman - University College LondonJoan T Merrill - Oklahoma Medical Research FoundationPaul R Fortin - Université LavalDafna D Gladman - Toronto Western HospitalIan N Bruce - Manchester University NHS Foundation TrustMichelle Petri - Johns Hopkins MedicineEllen M Ginzler - SUNY Downstate Health Sciences UniversityM A Dooley - University of North Carolina at Chapel HillKristjan Steinsson - Reykjavík UniversityRosalind Ramsey-Goldman - Northwestern UniversityAsad A Zoma - Hairmyres HospitalSusan Manzi - Allegheny Health NetworkOla Nived - Lund UniversityAndreas Jonsen - Lund UniversityMunther A Khamashta - St Thomas' HospitalGraciela S Alarcón - University of Alabama at BirminghamRonald F van Vollenhoven - Karolinska InstitutetCynthia Aranow - Feinstein Institute for Medical ResearchMeggan Mackay - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - University of the Basque CountryManuel Ramos-Casals - Hospital Clínic de BarcelonaS Sam Lim - Emory UniversityMurat Inanc - Istanbul UniversityKenneth C Kalunian - University of California, San DiegoSoren Jacobsen - Copenhagen University HospitalChristine A Peschken - University of ManitobaDiane L Kamen - Medical University of South CarolinaAnca Askanase - New York University Langone Orthopedic HospitalChris Theriault - Queen Elizabeth II Health Sciences CentreVernon Farewell - University of Cambridge
- Publication Details
- Arthritis & rheumatology (Hoboken, N.J.), v 71(2), pp 281-289
- Publisher
- Wiley
- Grant note
- P30 AR072579 / NIAMS NIH HHS UL1 TR001422 / NCATS NIH HHS UL1 RR025741 / NCRR NIH HHS P60 AR064464 / NIAMS NIH HHS P60-AR-48098 / NIH HHS MOP-88526 / CIHR A3865 / Danish Rheumatism Association MC_UU_00002/3 / Medical Research Council KL2 TR000107 / NCATS NIH HHS AR-69572 / NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000457458100013
- Scopus ID
- 2-s2.0-85060218857
- Other Identifier
- 991021933902804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology