Background Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune disease that has a wide variety of physical manifestations, including neuropsychiatric features. Bipolar Disorder (BD) is a chronic, phasic affective disorder that may present as depression or as mania. Neuropsychiatric symptoms in SLE develop in 20%>70% of SLE patients during the course of the disease and in half of these patients they precede the diagnosis of SLE1–4. In half of the patients, neuropsychiatric manifestations occur prior to the diagnosis of SLE5.
Objectives The objective of this study was to investigate the association between SLE and Bipolar Disorder (BD) using big data analysis methods.
Methods Patients with SLE were compared with age- and sex-matched controls regarding the proportion of BD in a cross-sectional study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis, adjusting for confounders. The study was performed utilizing the chronic disease registry of Clalit Health Services medical database.
Results The study included 5,018 SLE patients and 25,090 matched controls. BD was found in a higher proportion among SLE patients compared to controls (0.62% vs. 0.26%, respectively, p<0.001). BD patients had a greater proportion of smokers compared to non-BD patients (62.5% vs 23.5%, respectively, p<0.001). In a multivariate analysis, smoking and SLE were both found to be significantly associated with BD.
Conclusions SLE was found to be independently associated with BD. These findings may imply that an autoimmune process affecting the central nervous system among lupus patients facilitates the expression of concomitant BD.
Kivity S, Shoenfeld Y. Association between autoantibodies and neuropsychiatric manifestations of autoimmune disease: comment on the article by Lauvsnes et al. Arthritis Rheumatol 2015; 67(6):1683.
Meszaros ZS, Perl A, Faraone SV. Psychiatric symptoms in systemic lupus erythematosus: a systematic review. J Clin Psychiatry 2012; 73(7):993–1001.
Unterman A, Nolte JE, Boaz M, Abady M, Shoenfeld Y, Zandman-Goddard G. Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum 2011; 41(1):1–11.
Zandman-Goddard G, Chapman J, Shoenfeld Y. Autoantibodies involved in neuropsychiatric SLE and antiphospholipid syndrome. Semin Arthritis Rheum 2007; 36(5):297–315.
Kivity S, Agmon-Levin N, Zandman-Goddard G, Chapman J, Shoenfeld Y. Neuropsychiatric lupus: a mosaic of clinical presentations. BMC Med 2015; 13:43.
Disclosure of Interest None declared