Background Mood and anxiety disorders are frequently observed in systemic lupus erythematosus (SLE) patients, and there are, probably due to physical disability and stress of living with chronic disease. However, these symptoms have not been evaluatedover time in childhood-onset SLE (cSLE) so far.
Objectives To investigated mood and anxiety disorders pattern over time in cSLE. To explore potential relationships between mood and anxiety and clinical/laboratorial manifestations and treatment.
Methods Consecutive cSLE patients recruited from the Pediatric Rheumatology Outpatient Clinic of State University of Campinas were included in this study. We followed up 51 cSLEpatients for two years (baseline (T0), 6 (T1), 12 (T2) and 18 months (T3). Three patients in use of antidepressants were excluded.Clinical visits were scheduled semiannuallywithinterval visits scheduled when necessary due to diseaseactivity or complications. Mood and anxiety disorderswere determined through Becks Depression and Becks Anxiety Inventory in all participants. For patients under sixteen years old, Children's Depression Inventory (CDI) was applied.These scales consist of 21 items, each describing a common symptom of depression/anxiety. The respondent is asked to rate how much he or she has been bothered by each symptom over the past month on a 4-point scale ranging from 0 to 3. The items are summed to obtain a total score that can range from 0 to 63. The cutoffs used for the BDI are: 0–13: no/minimal depression; 14–19: mild depression; 20–28: moderate depression; and 29–63: severe depression and for the BAI: 0-7: no/minimal level of anxiety; 8-15: mild anxiety; 16-25: moderate anxiety; 26-63: severe anxiety. The cutoff used for CDI is 17. SLE patients were further assessed for clinical and laboratory SLE manifestations, disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] and current drug exposures. We used Mann-Whitney Test to compare the scores of BAI and BDI between the groups and to longitudinal analyses, we used Friedman Test.
Results We included 51cSLE patients (46 girls) with mean age of mean age of 16.15 [Standard deviation (SD) ±3.03 years; range 10-23]. Disease duration was 3.66 (SD ±3.0; range 1-12 years).We observed a significant variation in anxiety scores (p=0.04) and depression scores (p=0.02) over time. Cumulative damage was associated with a worsening of anxiety (p=0.01). No association between mood and anxiety disorders and disease activity (p>0.05) and corticosteroid dose (p>0.05) was observed. In addition, no difference in mood disorders in patients with and without immunosuppressant medication was observed.
Conclusions Mood and anxiety disorders have a significant variation over time in cSLEpatients. Cumulative damage is associated with worsening of anxiety incSLE patients.
Acknowledgements Grants: Research Support Foundation of São Paulo –FAPESP (Simone 2008/02917-0, Mariana 2011/03788-2, Aline 2013/09480-5, Nailú 2010/13637-9) CNPQ (300447/2009-4 and 471343/2011-0; 302205/2012-8; 473328/2013-5)
Disclosure of Interest None declared