Outcomes of neuropsychiatric events in systemic lupus erythematosus based on clinical phenotypes; prospective data from the Leiden NP SLE cohort

Abstract

Objective The objective of this study was to assess whether clinical and patient's reported outcomes are associated with a different pathophysiological origin of neuropsychiatric events presenting in systemic lupus erythematosus. Methods A total of 232 neuropsychiatric events presenting in 131 systemic lupus erythematosus patients were included. Neuropsychiatric systemic lupus erythematosus diagnosis was established per event by multidisciplinary evaluation. All neuropsychiatric events were divided according to a suspected underlying pathophysiological process into one of the following: non-neuropsychiatric systemic lupus erythematosus related, inflammatory and ischaemic neuropsychiatric systemic lupus erythematosus. The clinical outcome of all neuropsychiatric events was determined by a physician-completed four-point Likert scale. Health-related quality of life was measured with the subscales of the patient-generated Short Form 36 (SF-36) health survey questionnaire. The change between scores at paired visits of all domain scores, mental component summary (SF-36 MCS) and physical component summary (SF-36 PCS) scores were retrospectively calculated and used as patient-reported outcome. The association among these outcomes and the different origin of neuropsychiatric events was obtained using multiple logistic regression analysis. Results The clinical status of 26.8% non-neuropsychiatric systemic lupus erythematosus events, 15.8% ischaemic neuropsychiatric systemic lupus erythematosus and 51.6% inflammatory neuropsychiatric systemic lupus erythematosus improved after re-assessment. Almost all SF-36 domains had a positive change at re-assessment in all groups independently of the origin of neuropsychiatric events. Neuropsychiatric systemic lupus erythematosus ( B = 0.502; p < 0.001) and especially inflammatory neuropsychiatric systemic lupus erythematosus ( B = 0.827; p < 0.001) had better clinical outcome, with change in disease activity being the only important predictor. The change in SF-36 MCS was also independently associated with neuropsychiatric systemic lupus erythematosus ( B = 5.783; p < 0.05) and inflammatory neuropsychiatric systemic lupus erythematosus ( B = 11.133; p < 0.001). Disease duration and change in disease activity were the only predictors in both cases. The change in SF-36 PCS was only negatively associated with age. Conclusion Inflammatory neuropsychiatric systemic lupus erythematosus events have better clinical outcome and meaningful improvement in SF-36 MCS than ischaemic neuropsychiatric systemic lupus erythematosus or non-neuropsychiatric systemic lupus erythematosus.

Nervous System Disease in Systemic Lupus Erythematosus: Current Status and Future Directions

“…NP events are associated with a significant negative impact on patient‐reported health‐related quality of life (HRQoL), regardless of attribution and adjusting for global SLE disease activity, cumulative organ damage, and medications . Thus, all NP events are of clinical significance, but the treatment pathway is dependent on the correct attribution.…”

“…Given the paucity of clinical trials in NPSLE, information on treatment and outcomes is derived from observational studies and extrapolated from experience with other organ system disease in SLE and related disorders. Short‐term and long‐term outcomes of NP events are generally favorable, particularly for NP events attributed to SLE .…”

Comparative proteomics analysis of plasma protein in patients with neuropsychiatric systemic lupus erythematosus

“…It is reported that infection, lupus nephritis, hematological abnormality, NPSLE, and interstitial pneumonia are top causes of deaths in China (23). The two recognized underlying mechanisms of the immunopathogenesis of NPSLE were ischemic and inflammatory mechanisms, including blood-brain barrier dysfunction and production of pro-inflammatory cytokines which mediated by autoantibody (5,24). However, NPSLE pathogenesis is incompletely understood.…”

From Systemic Inflammation to Neuroinflammation: The Case of Neurolupus

“…Depending on the study, a varying number of SLE sufferers (from 15% to 75%) present with neuropsychiatric (NP) symptoms that cover the whole spectrum of psychiatric dysfunction [ 9 , 10 ]. These NP manifestations are associated with a reduced quality of life [ 11 , 12 , 13 ] and, when severe, they substantially contribute to the morbidity and mortality rates of SLE patients [ 14 ]. Nowadays, the etiology of NPSLE remains poorly understood, as is also the case for SLE and most autoimmune diseases.…”