Neuropsychiatric symptoms in systemic lupus erythematosus: impact on quality of life

Abstract

ObjectiveAssess quality of life in patients with systemic lupus erythematosus (SLE) presenting with neuropsychiatric symptoms (neuropsychiatric SLE, NPSLE).MethodsQuality of life was assessed using the Short-Form 36 item Health Survey (SF-36) in patients visiting the Leiden NPSLE clinic at baseline and at follow-up. SF-36 subscales and summary scores were calculated and compared with quality of life of the general Dutch population and patients with other chronic diseases.ResultsAt baseline, quality of life was assessed in 248 SLE patients, of whom 98 had NPSLE (39.7%). Follow-up data were available for 104 patients (42%), of whom 64 had NPSLE (61.5%). SLE patients presenting neuropsychiatric symptoms showed a significantly reduced quality of life in all subscales of the SF-36. Quality of life at follow-up showed a significant improvement in physical functioning role (p = 0.001), social functioning (p = 0.007), vitality (p = 0.023), mental health (p = 0.014) and mental component score (p = 0.042) in patients with neuropsychiatric symptoms not attributed to SLE, but no significant improvement was seen in patients with NPSLE.ConclusionQuality of life is significantly reduced in patients with SLE presenting neuropsychiatric symptoms compared with the general population and patients with other chronic diseases. Quality of life remains considerably impaired at follow-up. Our results illustrate the need for biopsychosocial care in patients with SLE and neuropsychiatric symptoms.

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“…Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystemic involvement presenting with numerous clinical manifestations (Kaul et al, 2016;Rahman and Isenberg, 2008). Neuropsychiatric systemic lupus erythematosus (NPSLE) involves neurologic manifestations seen in the central, peripheral, and autonomic nervous systems as well as psychiatric disorders in patients with SLE in which other causes have been excluded (Monahan et al, 2017;Pikman et al, 2017;Unterman et al, 2011;Zirkzee et al, 2014). Extensive research into the pathogenesis of NPSLE has been conducted, with the identification of many potential contributing factors, including autoantibodies (such as anti-NMDA receptors, anti-GABA receptors, anti-ribosomal P and anti-U1 RNP et.…”

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“…[4][5][6] SLE presents with a wide range of symptoms and signs. [7][8][9][10][11][12][13] Some of them are nonspecific (e.g. weakness, dizziness, lightheadedness, syncope, and fatigue) and may be a result of ANS dysfunction.…”

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“…The lack of improvement in QoL scores over time despite treatment is known in the literature 25,26 and could be related to different factors. [27][28][29][30][31] In general, patients with lupus were found to have lower satisfaction in life, a concept that has moderate to strong correlation with QoL. 32 In addition, Caucasian lupus patients have been shown to have a poorer physical function compared to non-Caucasians.…”