TY - JOUR T1 - To treat or not to treat with immunosuppressive therapy: psychiatric disorders in patients with systemic lupus erythematosus JF - Lupus Science & Medicine JO - Lupus Sci Med DO - 10.1136/lupus-2021-000629 VL - 9 IS - 1 SP - e000629 AU - Rory C Monahan AU - Anne M E Blonk AU - Tom WJ Huizinga AU - Margreet Kloppenburg AU - Huub A M Middelkoop AU - Nic J A van der Wee AU - Gerda M Steup-Beekman Y1 - 2022/01/01 UR - http://lupus.bmj.com/content/9/1/e000629.abstract N2 - Up to 65% of patients with SLE meet the criteria for a psychiatric disorder.1 Especially depression and anxiety are frequently present. Psychiatric disorders are important to recognise as they influence quality of life and treatment outcomes. As a myriad of causes may be responsible for psychiatric manifestations in patients with SLE, clinicians are often confronted with the question: to treat or not to treat with immunosuppressives?In the Leiden neuropsychiatric SLE (NPSLE) clinic, patients with SLE and neuropsychiatric symptoms are evaluated by a multidisciplinary team, including a psychiatrist and a clinical neuropsychologist.2 Neuropsychiatric symptoms are attributed to SLE in a consensus meeting based on clinical, radiological and laboratory assessment, which has been described in detail previously and is similar to the proposed classification criteria for NPSLE.3 4 As the clinic has now existed for over 10 years, we have accumulated experience in the diagnosis and treatment of different psychiatric manifestations. Here, we provide an overview of these psychiatric manifestations and the need for immunosuppressive therapy in patients with SLE visiting our NPSLE clinic between 2007 and 2019. Psychiatric disorders were coded according to the Fifth Version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).5 The presence of a cognitive disorder was based on extensive formal cognitive assessment.6 Among 371 patients with SLE who visited our clinic in that time period, the mean age was 43 years (SD: 13), 87% were female and … ER -