Objective To identify the incidence, risk factors and prognosis for neuropsychiatric lupus (NPSLE) in Korea.

Methods 1121 patients with SLE from Hanyang BAE lupus cohort were enrolled and followed from 1998 to 2015. NPSLE was defined using the ACR case definitions and Ainiala Criteria. Demographics and clinical information including ACR Classification criteria for SLE, autoantibodies, SLE Disease Activity Index, the SLICC/ACR damage index (DI) were collected at baseline and then annually. Symptoms of NPSLE were collected from patient interview and medical records. Mortality data were derived by linking with data from the Korean National Statistics Office (KNSO). Multivariable logistic regression and cox regression test were performed to assess the risk factor of NPSLE and predictors of mortality.

Results Of 1121 SLE patients, 429 (38.2%) patients had NPSLE events according to ACR definitions and 216 (19.3%) by Ainiala criteria. In multivariable logistic regression analysis, year of education [Odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87 to 0.96, p<0.01] and elevated anti-dsDNA antibodies (OR 0.52, CI: 0.37 to 0.76, p<0.01) decreased the risk of NPSLE. In multivariable cox regression analysis, SLEDAI without NP manifestations at enrollment increased the risk of mortality (OR 1.18, CI: 1.08 to 1.25, p<0.01) in NPSLE patients.

Conclusion The 38.2% and 19.3% of SLE patients had NPSLE according to ACR and Ainiala definition of NPSLE. Year of education and elevated anti-dsDNA antibodies decreased the risk of occurrence of NPSLE. SLEDAI without NP manifestations at enrollment increased the risk of mortality in NPSLE patients.