RT Journal Article
SR Electronic
T1 Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 356
OP 362
DO 10.1136/annrheumdis-2019-216150
VO 79
IS 3
A1 John G Hanly
A1 Murray B Urowitz
A1 Caroline Gordon
A1 Sang-Cheol Bae
A1 Juanita Romero-Diaz
A1 Jorge Sanchez-Guerrero
A1 Sasha Bernatsky
A1 Ann E Clarke
A1 Daniel J Wallace
A1 David A Isenberg
A1 Anisur Rahman
A1 Joan T Merrill
A1 Paul R Fortin
A1 Dafna D Gladman
A1 Ian N Bruce
A1 Michelle Petri
A1 Ellen M Ginzler
A1 Mary Anne Dooley
A1 Rosalind Ramsey-Goldman
A1 Susan Manzi
A1 Andreas Jönsen
A1 Graciela S Alarcón
A1 Ronald F van Vollenhoven
A1 Cynthia Aranow
A1 Meggan Mackay
A1 Guillermo Ruiz-Irastorza
A1 Sam Lim
A1 Murat Inanc
A1 Kenneth C Kalunian
A1 Søren Jacobsen
A1 Christine A Peschken
A1 Diane L Kamen
A1 Anca Askanase
A1 Vernon Farewell
YR 2020
UL http://ard.bmj.com/content/79/3/356.abstract
AB Objectives Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients.Methods Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states.Results NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001).Conclusions NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.