Outcomes of neuropsychiatric events in systemic lupus erythematosus based on clinical phenotypes; prospective data from the Leiden NP SLE cohort : Outcomes of neuropsychiatric events in SLE
2016
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.
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