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Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study.

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Authors
Hanly, John G
Li, Qiuju
Su, Li
Urowitz, Murray B
Gordon, Caroline
Bae, Sang-Cheol
Romero-Diaz, Juanita
Sanchez-Guerrero, Jorge
Bernatsky, Sasha
Clarke, Ann E
Wallace, Daniel J
Isenberg, David A
Rahman, Anisur
Merrill, Joan T
Fortin, Paul R
Gladman, Dafna D
Bruce, Ian N
Petri, Michelle
Ginzler, Ellen M
Dooley, M A
Steinsson, Kristjan
Ramsey-Goldman, Rosalind
Zoma, Asad A
Manzi, Susan
Nived, Ola
Jonsen, Andreas
Khamashta, Munther A
Alarcón, Graciela S
van Vollenhoven, Ronald F
Aranow, Cynthia
Mackay, Meggan
Ruiz-Irastorza, Guillermo
Ramos-Casals, Manuel
Lim, S Sam
Inanc, Murat
Kalunian, Kenneth C
Jacobsen, Soren
Peschken, Christine A
Kamen, Diane L
Askanase, Anca
Theriault, Chris
Farewell, Vernon
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Issue Date
2019-02-01

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Citation
Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. 2019, 71(2):281-289 Arthritis Rheumatol.
Abstract
To determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (SLE), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short- and long-term outcomes as assessed by physicians and patients. Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (SF-36) were recorded. Time to event and linear regressions were used as appropriate. Of 1,826 SLE patients, 88.8% were female and 48.8% were Caucasian. The mean ± SD age was 35.1 ± 13.3 years, the mean ± SD disease duration was 5.6 ± 4.2 months, and the mean ± SD follow-up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [HRs] and 95% confidence intervals [95% CIs]) with lupus psychosis were previous SLE NP events (HR 3.59 [95% CI 1.16-11.14]), male sex (HR 3.0 [95% CI 1.20-7.50]), younger age at SLE diagnosis (per 10 years) (HR 1.45 [95% CI 1.01-2.07]), and African ancestry (HR 4.59 [95% CI 1.79-11.76]). By physician assessment, most psychotic events resolved by the second annual visit following onset, in parallel with an improvement in patient-reported SF-36 summary and subscale scores. Psychosis is an infrequent manifestation of NPSLE. Generally, it occurs early after SLE onset and has a significant negative impact on health status. As determined by patient and physician report, the short- and long-term outlooks are good for most patients, although careful follow-up is required.
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https://onlinelibrary.wiley.com/doi/full/10.1002/art.40764
ae974a485f413a2113503eed53cd6c53
10.1002/art.40764
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English Journal Articles (Peer Reviewed)

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