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Abstract
Purpose Neuropsychiatric damage (ND) is a major determinant of morbidity in SLE. We analysed ND in a group of deceased SLE patients and identified features associated with ND.
Methods We retrospectively analysed 90 patients (68 females) deceased during 2002–2011. All patients fulfilled at least 4 classification criteria of the ACR. We identified patients with ND, as defined by the SLICC/ACR damage index, and its components: cognitive impairment/major psychosis (CIMP), seizures, cerebrovascular accident (CA), cranial/peripheral neuropathy and transverse myelitis (TM). Following variables were compared between patients with and without ND (ND +and ND, respectively): demographics, ACR criteria at diagnosis and cumulatively at death (available at diagnosis for 73 patients), damage and its components one year following diagnosis and at death, disease activity (ECLAM) at diagnosis, components of the metabolic syndrome, smoking and immunosuppressive treatment. Frequencies were compared using the chi-square and Fisher´s exact test, and continuous variables using the t-test and Mann-Whitney U-test. Variables associated with ND were included in a multivariate logistic regression model.
Results We identified 44/90 ND +patients: 17/44 with CIMP, 6/44 with seizures, 21/44 with CA, 20/44 with neuropathy, none with TM. ND +patients had a higher cumulative count of ACR criteria compared to their ND- counterparts (6.02±1.23 vs 5.39±1.26). They had a higher proportion of neurologic disorder (NRL-D) (6/37 vs 0/36) and a lower proportion of serositis (4/37 vs 11/36) at diagnosis, as well as higher cumulative proportions of NRL-D (9/44 vs 2/46), hematologic disorder (41/44 vs 34/46) and lymphopenia (34/44 vs 24/46) (p<0.05). ND +patients also had higher cumulative damage (6.43±3.13 vs 3.43±2.54), higher cumulative proportions of pulmonary (14/44 vs 6/46) and musculoskeletal damage (MSKD) (32/44 vs 21/46), and higher proportions of arterial hypertension (40/44 vs 34/46), secondary sicca (17/44 vs 9/46) and Hughes syndrome (11/44 vs 4/46) (p<0.05). Serositis at diagnosis and cumulative MSKD were associated with ND in the multivariate model (OR 0.17 (95% CI: 0.03 to 0.89) and 6.00 (95% CI: 1.64 to 21.91), respectively).
Conclusions Serositis may be associated with a lower likelihood of ND, while NRL-D was present at diagnosis only in patients that accrued ND. The association between MSKD and ND requires further elucidation.
