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Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach

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  • John G Hanly
  • Murray B Urowitz
  • Caroline Gordon
  • Sang-Cheol Bae
  • Juanita Romero-Diaz
  • Jorge Sanchez-Guerrero
  • Sasha Bernatsky
  • Ann E Clarke
  • Daniel J Wallace
  • David A Isenberg
  • Anisur Rahman
  • Joan T Merrill
  • Paul R Fortin
  • Dafna D Gladman
  • Ian N Bruce
  • Michelle Petri
  • Ellen M Ginzler
  • Mary Anne Dooley
  • Rosalind Ramsey-Goldman
  • Susan Manzi
  • Andreas Jönsen
  • Graciela S Alarcón
  • Ronald F van Vollenhoven
  • Cynthia Aranow
  • Meggan Mackay
  • Guillermo Ruiz-Irastorza
  • Sam Lim
  • Murat Inanc
  • Kenneth C Kalunian
  • Søren Jacobsen
  • Christine A Peschken
  • Diane L Kamen
  • Anca Askanase
  • Vernon Farewell
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OBJECTIVES: Using 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.

METHODS: Annual 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.

RESULTS: NP 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).

CONCLUSIONS: NP 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.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Volume79
Issue number3
Pages (from-to)356-362
Number of pages7
ISSN0003-4967
DOIs
Publication statusPublished - Mar 2020

    Research areas

  • Adult, Female, Humans, Longitudinal Studies, Lupus Erythematosus, Systemic/mortality, Lupus Vasculitis, Central Nervous System/mortality, Male, Middle Aged, Models, Statistical, Multilevel Analysis, Prospective Studies, Quality of Life, autoimmune diseases, outcomes research, epidemiology, systemic lupus erythematosus

ID: 61876663