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Rigshospitalet - a part of Copenhagen University Hospital

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

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  • John G Hanly
  • Qiuju Li
  • Li Su
  • 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
  • M A Dooley
  • Kristjan Steinsson
  • Rosalind Ramsey-Goldman
  • Asad A Zoma
  • Susan Manzi
  • Ola Nived
  • Andreas Jonsen
  • Munther A Khamashta
  • Graciela S Alarcón
  • Ronald F van Vollenhoven
  • Cynthia Aranow
  • Meggan Mackay
  • Guillermo Ruiz-Irastorza
  • Manuel Ramos-Casals
  • S Sam Lim
  • Murat Inanc
  • Kenneth C Kalunian
  • Søren Jacobsen
  • Christine A Peschken
  • Diane L Kamen
  • Anca Askanase
  • Chris Theriault
  • Vernon Farewell
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OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Original languageEnglish
JournalArthritis & rheumatology
Issue number2
Pages (from-to)281-289
Number of pages9
Publication statusPublished - Feb 2019

    Research areas

  • Adult, Age Factors, Antibodies, Anticardiolipin/immunology, Autoantibodies/immunology, Cohort Studies, Female, Humans, Kaplan-Meier Estimate, Linear Models, Lupus Coagulation Inhibitor/immunology, Lupus Erythematosus, Systemic/epidemiology, Lupus Vasculitis, Central Nervous System/epidemiology, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Psychotic Disorders/epidemiology, Receptors, N-Methyl-D-Aspartate/immunology, Sex Factors, Young Adult, beta 2-Glycoprotein I/immunology

ID: 58899782