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

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

Research output: Contribution to journalArticle

Abstract

Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)281-289
Number of pages9
JournalArthritis and Rheumatology
Volume71
Issue number2
DOIs
StatePublished - Feb 1 2019

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Systemic Lupus Erythematosus
Psychotic Disorders
Cohort Studies
Confidence Intervals
Physicians
Central Nervous System Lupus Vasculitis
Sex Ratio
Autoantibodies
Health Status
Linear Models

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology

Cite this

Hanly, J. G., Li, Q., Su, L., Urowitz, M. B., Gordon, C., Bae, S. C., ... Farewell, V. (2019). Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis and Rheumatology, 71(2), 281-289. https://doi.org/10.1002/art.40764

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

In: Arthritis and Rheumatology, Vol. 71, No. 2, 01.02.2019, p. 281-289.

Research output: Contribution to journalArticle

Hanly, JG, Li, Q, Su, L, Urowitz, MB, Gordon, C, Bae, SC, Romero-Diaz, J, Sanchez-Guerrero, J, Bernatsky, S, Clarke, AE, Wallace, DJ, Isenberg, DA, Rahman, A, Merrill, JT, Fortin, PR, Gladman, DD, Bruce, IN, Petri, M, Ginzler, EM, Dooley, MA, Steinsson, K, Ramsey-Goldman, R, Zoma, AA, Manzi, S, Nived, O, Jonsen, A, Khamashta, MA, Alarcón, GS, van Vollenhoven, RF, Aranow, C, Mackay, M, Ruiz-Irastorza, G, Ramos-Casals, M, Lim, SS, Inanc, M, Kalunian, KC, Jacobsen, S, Peschken, CA, Kamen, DL, Askanase, A, Theriault, C & Farewell, V 2019, 'Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study', Arthritis and Rheumatology, vol. 71, no. 2, pp. 281-289. https://doi.org/10.1002/art.40764
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. / Psychosis in Systemic Lupus Erythematosus : Results From an International Inception Cohort Study. In: Arthritis and Rheumatology. 2019 ; Vol. 71, No. 2. pp. 281-289.
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abstract = "Objective: 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. Methods: 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. Results: 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. Conclusion: 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.",
author = "Hanly, {John G.} and Qiuju Li and Li Su and Urowitz, {Murray B.} and Caroline Gordon and Bae, {Sang Cheol} and Juanita Romero-Diaz and Jorge Sanchez-Guerrero and Sasha Bernatsky and Clarke, {Ann E.} and Wallace, {Daniel J.} and Isenberg, {David A.} and Anisur Rahman and Merrill, {Joan T.} and Fortin, {Paul R.} and Gladman, {Dafna D.} and Bruce, {Ian N.} and Michelle Petri and Ellen M Ginzler and Dooley, {M. A.} and Kristjan Steinsson and Rosalind Ramsey-Goldman and Zoma, {Asad A.} and Susan Manzi and Ola Nived and Andreas Jonsen and Khamashta, {Munther A.} and Alarc{\'o}n, {Graciela S.} and {van Vollenhoven}, {Ronald F.} and Cynthia Aranow and Meggan Mackay and Guillermo Ruiz-Irastorza and Manuel Ramos-Casals and Lim, {S. Sam} and Murat Inanc and Kalunian, {Kenneth C.} and Soren Jacobsen and Peschken, {Christine A.} and Kamen, {Diane L.} and Anca Askanase and Chris Theriault and Vernon Farewell",
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month = "2",
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doi = "10.1002/art.40764",
language = "English (US)",
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pages = "281--289",
journal = "Arthritis and Rheumatology",
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TY - JOUR

T1 - Psychosis in Systemic Lupus Erythematosus

T2 - Results From an International Inception Cohort Study

AU - Hanly, John G.

AU - Li, Qiuju

AU - Su, Li

AU - Urowitz, Murray B.

AU - Gordon, Caroline

AU - Bae, Sang Cheol

AU - Romero-Diaz, Juanita

AU - Sanchez-Guerrero, Jorge

AU - Bernatsky, Sasha

AU - Clarke, Ann E.

AU - Wallace, Daniel J.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Merrill, Joan T.

AU - Fortin, Paul R.

AU - Gladman, Dafna D.

AU - Bruce, Ian N.

AU - Petri, Michelle

AU - Ginzler, Ellen M

AU - Dooley, M. A.

AU - Steinsson, Kristjan

AU - Ramsey-Goldman, Rosalind

AU - Zoma, Asad A.

AU - Manzi, Susan

AU - Nived, Ola

AU - Jonsen, Andreas

AU - Khamashta, Munther A.

AU - Alarcón, Graciela S.

AU - van Vollenhoven, Ronald F.

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Ruiz-Irastorza, Guillermo

AU - Ramos-Casals, Manuel

AU - Lim, S. Sam

AU - Inanc, Murat

AU - Kalunian, Kenneth C.

AU - Jacobsen, Soren

AU - Peschken, Christine A.

AU - Kamen, Diane L.

AU - Askanase, Anca

AU - Theriault, Chris

AU - Farewell, Vernon

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Objective: 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. Methods: 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. Results: 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. Conclusion: 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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