TY - JOUR
T1 - Mood disorders in systemic lupus erythematosus
T2 - Results from an international inception cohort study
AU - Hanly, John G.
AU - Su, Li
AU - Urowitz, Murray B.
AU - Romero-Diaz, Juanita
AU - Gordon, Caroline
AU - Bae, Sang Cheol
AU - Bernatsky, Sasha
AU - Clarke, Ann E.
AU - Wallace, Daniel J.
AU - Merrill, Joan T.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Ginzler, Ellen M.
AU - Petri, Michelle
AU - Bruce, Ian N.
AU - Dooley, M. A.
AU - Fortin, Paul
AU - Gladman, Dafna D.
AU - Sanchez-Guerrero, Jorge
AU - Steinsson, Kristjan
AU - Ramsey-Goldman, Rosalind
AU - Khamashta, Munther A.
AU - Aranow, Cynthia
AU - Alarcón, Graciela S.
AU - Fessler, Barri J.
AU - Manzi, Susan
AU - Nived, Ola
AU - Sturfelt, Gunnar K.
AU - Zoma, Asad A.
AU - Van Vollenhoven, Ronald F.
AU - Ramos-Casals, Manuel
AU - Ruiz-Irastorza, Guillermo
AU - Lim, S. Sam
AU - Kalunian, Kenneth C.
AU - Inanc, Murat
AU - Kamen, Diane L.
AU - Peschken, Christine A.
AU - Jacobsen, Soren
AU - Askanase, Anca
AU - Theriault, Chris
AU - Thompson, Kara
AU - Farewell, Vernon
N1 - Publisher Copyright:
© 2015, American College of Rheumatology.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Objective To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). Methods Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. Results Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean± SD age of the patients was 35.1±13.3 years, disease duration was 5.6±4.8 months, and the length of followup was 4.7±3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P≤0.01), and a lower risk was associated with Asian race/ethnicity (P=0.01) and treatment with immunosuppressive drugs (P=0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. Conclusion Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.
AB - Objective To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). Methods Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. Results Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean± SD age of the patients was 35.1±13.3 years, disease duration was 5.6±4.8 months, and the length of followup was 4.7±3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P≤0.01), and a lower risk was associated with Asian race/ethnicity (P=0.01) and treatment with immunosuppressive drugs (P=0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. Conclusion Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.
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U2 - 10.1002/art.39111
DO - 10.1002/art.39111
M3 - Article
C2 - 25778456
AN - SCOPUS:84933059999
SN - 2326-5191
VL - 67
SP - 1837
EP - 1847
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
IS - 7
ER -