Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach
- 8 January 2020
- journal article
- research article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 79 (3), 356-362
- https://doi.org/10.1136/annrheumdis-2019-216150
Abstract
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 (pConclusions 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.Funding Information
- Canadian Institutes of Health Research (grant MOP-88526)
This publication has 24 references indexed in Scilit:
- Nervous System Disease in Systemic Lupus Erythematosus: Current Status and Future DirectionsArthritis & Rheumatology, 2018
- Multistate Models for the Analysis of Life History DataPublished by Taylor & Francis Ltd ,2018
- Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: a prospective, single-center studyLupus, 2018
- Diagnosis and management of neuropsychiatric SLENature Reviews Rheumatology, 2014
- Short‐term outcome of neuropsychiatric events in systemic lupus erythematosus upon enrollment into an international inception cohort studyArthritis Care & Research, 2008
- Systemic Lupus International Collaborating Group—onwards and upwards?Lupus, 2006
- Validity of the new American College of Rheumatology criteria for neuropsychiatric lupus syndromes: a population‐based evaluationArthritis & Rheumatism, 2001
- The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromesArthritis & Rheumatism, 1999
- Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosusArthritis & Rheumatism, 1997
- The development and initial validation of the systemic lupus international collaborating clinics/American college of rheumatology damage index for systemic lupus erythematosusArthritis & Rheumatism, 1996