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Prospective analysis of neuropsychiatric events in an international disease inception cohort of SLE patients
  1. J G Hanly (john.hanly{at}cdha.nshealth.ca)
  1. QEII Health Sciences Centre and Dalhousie University, Canada
    1. M B Urowitz (m.urowitz{at}utoronto.ca)
    1. Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Canada
      1. L Su
      1. Institute of Public Health, University Forvie Site, United Kingdom
        1. S C Bae
        1. The Hospital for Rheumatic Diseases and Hanyang University Medical Center, Korea, Democratic People's Republic of
          1. C Gordon
          1. College of Medical and Dental Sciences, University of Birmingham, United Kingdom
            1. D J Wallace
            1. Cedars-Sinai/David Geffen School of Medicine at UCLA, United States
              1. A Clarke
              1. Montreal General Hospital, McGill University Health Centre, Canada
                1. S Bernatsky
                1. Montreal General Hospital, McGill University Health Centre, Canada
                  1. D Isenberg
                  1. Centre for Rheumatology Research, University College, United Kingdom
                    1. A Anisur
                    1. Centre for Rheumatology Research, University College, United Kingdom
                      1. G S Alarcon
                      1. University of Alabama at Birmingham, United States
                        1. D D Gladman
                        1. Toronto Western Hospital and University of Toronto, Canada
                          1. P R Fortin
                          1. Toronto Western Hospital and University of Toronto, Canada
                            1. J Sanchez-Guerrero
                            1. Instituto Nacional de Ciencias Medicas y Nutricion, Mexico
                              1. J Romero-Diaz
                              1. Instituto Nacional de Ciencias Medicas y Nutricion, Mexico
                                1. J T Merrill
                                1. Oklahoma Medical Research Foundation, United States
                                  1. E Ginzler
                                  1. SUNY Downstate Medical Center, United States
                                    1. I N Bruce
                                    1. The Kellgren Centre for Rheumatology, University of Manchester, United Kingdom
                                      1. K Steinsson
                                      1. Landspitali University Hospital, Iceland
                                        1. M Khamashta
                                        1. the Rayne Institute, St Thomas Hospital, King's College London School of Medicine, United Kingdom
                                          1. M Petri
                                          1. Johns Hopkins University, United States
                                            1. S Manzi
                                            1. University of Pittsburgh School of Medicine, United States
                                              1. MA Dooley
                                              1. University of North Carolina, United States
                                                1. R Ramsey-Goldman
                                                1. Northwestern University and Feinberg School of Medicine, United States
                                                  1. R van Vollenhoven
                                                  1. Karolinska University, Sweden
                                                    1. O Nived
                                                    1. University Hospital Lund, Sweden
                                                      1. G Sturfelt
                                                      1. University Hospital Lund, Sweden
                                                        1. C Aranow
                                                        1. Columbia University Medical Centre, United States
                                                          1. K Kalunian
                                                          1. UCSD School of Medicine, United States
                                                            1. M Ramos-Casals
                                                            1. Servicio Enfermedades Autoimmunes Hospital Clinico y Provincial, Spain
                                                              1. A Zoma
                                                              1. Lanarkshire Centre for Rheumatology, Hairmyres Hospital, United Kingdom
                                                                1. J Douglas
                                                                1. QEII Health Sciences Centre and Dalhousie University, Canada
                                                                  1. K Thompson
                                                                  1. QEII Health Sciences Centre and Dalhousie University, Canada
                                                                    1. V Farewell
                                                                    1. Institute of Public Health, University Forvie Site, United Kingdom

                                                                      Abstract

                                                                      Objectives: To determine the frequency, accrual, attribution and outcome of neuropsychiatric (NP) events and impact on quality of life over 3 years in a large inception cohort of SLE patients.

                                                                      Methods: The study was conducted by the Systemic Lupus International Collaborating Clinics. Patients were enrolled within 15 months of SLE diagnosis. NP events were identified using the ACR case definitions and decision rules were derived to determine the proportion of NP disease attributable to SLE. The outcome of NP events was recorded and patient perceived impact determined by the SF-36.

                                                                      Results: There were 1206 patients (89.6% female) with a mean (±SD) age of 34.5±13.2 years. The mean disease duration at enrollment was 5.4±4.2 months. Over a mean follow-up of 1.9±1.2 years 486/1206 (40.3%) patients had ≥1 NP events which were attributed to SLE in 13.0%-23.6% of patients using two a priori decision rules. The frequency of individual NP events varied from 47.1% (headache) to 0% (myasthenia gravis). The outcome was significantly better for those NP events attributed to SLE especially if they occurred within 1.5 years of the diagnosis of SLE. Patients with NP events, regardless of attribution, had significantly lower summary scores for both mental and physical health over the study.

                                                                      Conclusions: NP events in SLE patients are variable in frequency, most commonly present early in the disease course and adversely impact patients¡¯ quality of life over time. Events attributed to non-SLE causes are more common than those due to SLE, although the latter have a more favourable outcome.

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