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Autoantibodies and neuropsychiatric events at the time of systemic lupus erythematosus diagnosis: results from an international inception cohort study

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Authors
Hanly, J G
Urowitz, M B
Siannis, F
Farewell, V
Gordon, C
Bae, S C
Isenberg, D
Dooley, M A
Clarke, A
Bernatsky, S
Gladman, D
Fortin, P R
Manzi, S
Steinsson, K
Bruce, I N
Ginzler, E
Aranow, C
Wallace, D J
Ramsey-Goldman, R
van Vollenhoven, R
Sturfelt, G
Nived, O
Sanchez-Guerrero, J
Alarcón, G S
Petri, M
Khamashta, M
Zoma, A
Font, J
Kalunian, K
Douglas, J
Qi, Q
Thompson, K
Merrill, J T
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Issue Date
2008-03-01

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Citation
Arthritis Rheum. 2008, 58(3):843-53
Abstract
OBJECTIVE: To examine, in an inception cohort of systemic lupus erythematosus (SLE) patients, the association between neuropsychiatric (NP) events and anti-ribosomal P (anti-P), antiphospholipid (lupus anticoagulant [LAC], anticardiolipin), anti-beta2-glycoprotein I, and anti-NR2 glutamate receptor antibodies. METHODS: NP events were identified using the American College of Rheumatology case definitions and clustered into central/peripheral and diffuse/focal events. Attribution of NP events to SLE was determined using decision rules of differing stringency. Autoantibodies were measured without knowledge of NP events or their attribution. RESULTS: Four hundred twelve patients were studied (87.4% female; mean +/- SD age 34.9 +/- 13.5 years, mean +/- SD disease duration 5.0 +/- 4.2 months). There were 214 NP events in 133 patients (32.3%). The proportion of NP events attributed to SLE varied from 15% to 36%. There was no association between autoantibodies and NP events overall. However, the frequency of anti-P antibodies in patients with central NP events attributed to SLE was 4 of 20 (20%), versus 3 of 107 (2.8%) in patients with other NP events and 24 of 279 (8.6%) in those with no NP events (P = 0.04). Among patients with diffuse NP events, 3 of 11 had anti-P antibodies (27%), compared with 4 of 111 patients with other NP events (3.6%) and 24 of 279 of those with no NP events (8.6%) (P = 0.02). Specific clinical-serologic associations were found between anti-P and psychosis attributed to SLE (P = 0.02) and between LAC and cerebrovascular disease attributed to SLE (P = 0.038). There was no significant association between other autoantibodies and NP events. CONCLUSION: Clinically distinct NP events attributed to SLE and occurring around the time of diagnosis were found to be associated with anti-P antibodies and LAC. This suggests that there are different autoimmune pathogenetic mechanisms, although low sensitivity limits the clinical application of testing for these antibodies.
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http://dx.doi.org/10.1002/art.23218
ae974a485f413a2113503eed53cd6c53
10.1002/art.23218
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