Background Hydroxychloroquine (HCQ) is a key immunomodulatory treatment in systemic lupus erythematosus (SLE) with pleiotropic effects. Beyond anti-thrombotic, anti-atherosclerotic and anti-diabetic effects, anti-microbial and anti-cancer are possible roles. Neuropsychiatric symptoms, mostly headaches, depression, anxiety and cognitive impairment, affect nearly half of patients. Several pathways have been identified: antibody-mediated/cytokine-induced neurotoxicity, vasculopathy and loss of neuroplasticity. Thus, we hypothesized if there is a role for HCQ in preventing depression in jSLE.

Methods A cross-sectional sample of juvenile-onset SLE (jSLE) patients, currently aged ≥ 16 years, completed a psychosocial assessment including the SF-36, HADS, SHS, BriefCope and MMSE questionnaires, between October 2018- May 2019. Local Ethics Committee approved the study. All patients fulfilled both 2012 and 2019 EULAR/ACR classification criteria for SLE. Juvenile-onset was defined as age at diagnosis <18 years. Demographics and clinical characteristics were collected. Statistical analysis was performed with SPSS®.

Results 30 jSLE patients were included (90%female) in the study, with median age of 21 years, being the youngest 16 and the oldest 35, with mean (SD) age of diagnosis of 15.8 ± 2.1. Mean values (SD) of psychosocial assessment were: SHS 5.2 (1.02); MMSE of 27.7 (1.8); Physical health SF-36 of 66.8 (9.9) and Mental health SF-36 of 68.9 (17.5). 23.3% jSLE showed mild cognitive impairment, 63.3% anxiety and 13.3% depression. From the 27 jSLE treated with HCQ, those had better results in the SHS (p=0.030) and scored lower in scores in the Hospital Anxiety and Depression scale (p=0.023). Interestingly, this also occurs for emotion focused coping, with significantly better results in jSLE taking HCQ (p=0.001).

Conclusions Young adults with SLE are at risk for depression and HCQ may have a role in preventing it. Longitudinal studies will permit to confirm present results and clarify the role of coping strategies in the occurrence of depression in jSLE.