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

Research output: Contribution to journalArticle

Abstract

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.

Details

Authors
  • 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
  • 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
  • Soren Jacobsen
  • Christine A. Peschken
  • Diane L. Kamen
  • Anca Askanase
  • Chris Theriault
  • Vernon Farewell
Organisations
External organisations
  • Dalhousie University
  • University of Cambridge
  • University of Toronto
  • University of Birmingham
  • Hanyang University
  • Instituto Nacional de Ciencias Médicas y Nutrición
  • McGill University
  • University of Calgary
  • Jonsson Comprehensive Cancer Center
  • University College London
  • Oklahoma Medical Research Foundation
  • Laval University
  • Christie NHS Foundation Trust
  • Johns Hopkins University School of Medicine
  • State University of New York Downstate Medical Center
  • University of North Carolina
  • National University Hospital of Iceland
  • Northwestern University
  • Hairmyres Hospital
  • Allegheny Health Network
  • Guy's and St Thomas' NHS Foundation Trust
  • University of Alabama
  • Karolinska Institutet
  • Feinstein Institute for Medical Research
  • University of the Basque Country
  • Hospital Clínic of Barcelona
  • Emory University
  • Istanbul University
  • Copenhagen University Hospital
  • University of Manitoba
  • Medical University of South Carolina
  • Indian Institute of Technology
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Rheumatology and Autoimmunity
Original languageEnglish
Pages (from-to)281-289
JournalArthritis and Rheumatology
Volume71
Issue number2
Early online date2019
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes