Lupus-related neuropsychiatric events linked to active disease, corticosteroids
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Neuropsychiatric events caused by systemic lupus erythematosus are associated with active disease, male sex, corticosteroids and concurrent non-lupus events, except headaches, according to data published in Arthritis & Rheumatology.
“Recent studies suggest that approximately 30-50% of all [neuropsychiatric (NP)] events in SLE patients are attributable to SLE although the exact proportion varies depending on the type of NP event,” John G. Hanly, MD, of the Queen Elizabeth II Health Sciences Center and Dalhousie University, in Halifax, Canada, and colleagues wrote. “Prospective, observational cohort studies of SLE patients have reported differences in the outcome of NP events depending, in part, on their attribution to SLE and non-SLE causes.”
“In a recent study, using multistate modeling at the patient level, we reported the occurrence, attribution and outcome of all NP events in SLE patients,” they added. “Regardless of attribution, NP events occurred most frequently around the diagnosis of SLE and had a significant negative impact on health-related quality of life (HRQoL). Although the majority of NP events resolved over time, patients with NP events attributed to SLE had a higher mortality rate.”
To further examine the predictors of changes in neuropsychiatric event status in patients with SLE, Hanly and colleagues conducted a prospective, international, inception cohort study, based on based on a multistate modelling approach and attribution rules they used previously. The study, conducted through the Systemic Lupus International Collaborating Clinics (SLICC), which includes 52 investigators across 43 centers in 16 countries, recruited participants from 31 SLICC sites in Asia, Europe and North America.
In all, the study included 1,827 participants with SLE, recruited over a period of 11 years — from 1999 to 2011 — at a maximum of 15 months following diagnosis. Upon enrollment and annually thereafter, the researchers documented all neuropsychiatric events attributed to SLE and non-SLE causes. They used time-to-event analysis and a multistate modeling structure to examine factors potentially associated with the onset and resolution of neuropsychiatric events.
According to the researchers, neuropsychiatric events occurred in 52.3% of participants. Of the 1,910 total unique events, 31% were attributed to SLE causes. Among the SLE-attributable events, multivariate analysis demonstrated positive associations with male sex, concurrent non-SLE events — except headache — active disease and corticosteroid use. Meanwhile, there was a negative association with Asian ancestry, post-secondary education and immunosuppressive or anti-malarial use.
Among the non-SLE events — excluding headache — there was a positive association with concurrent SLE-attributable events and negative associations with Asian and African ancestry.
SLE-attributable events demonstrated a higher resolution rate than non-SLE events, with the exception of headache, which had comparable resolution rates. In SLE events, multivariate analysis suggested that resolution was more common among Asian individuals, as well as for central or focal events. In non-SLE events resolution was more common among individuals with African ancestry and less common with older age at SLE diagnosis.
“The results of our study indicate heterogeneity in the occurrence, resolution and recurrence of different NP events and in predictors for same over time,” Hanly and colleagues wrote. “As multiple NP events due to different causes may present concurrently in individual patients, the findings emphasize the importance of recognizing attribution of NP events as a determinant of clinical outcome.”
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