Background: Neuropsychiatric (NP) involvement represents a major cause of morbidity and mortality in Systemic Lupus Erythematosus (SLE) patients and appears strongly related to the presence of antiphospholipid antibodies. Objectives: To evaluate, by a retrospective cross-sectional case-control multicentric study from 8 italian rheumatology institutions, the distribution of a number of risk factors and co-morbidities potentially related to central nervous system involvement in a large cohort of SLE patients without antiphospholipid antibodies. Methods: From a large Italian multicentric cohort of patients with SLE a sub-analysis including only those patients negative for aPL (aCL, LA and anti-b2GP1) was performed comparing the distribution of a number of ''generic'' (i.e. not strictly SLE related: hypertension, diabetes, atherosclerosis, dyslipidemia, smoking, hyperhomocysteinemia, glucocorticosteroids, ecc.) and ''specific'' (i.e. disease-related: anti-Sm and anti Ro/SSA antibodies, cutaneous vasculitis, Sjogren's syndrome, ecc) risk factors. Results: From the entire cohort of 959 SLE patients, 100 SLE patients with neuropsychiatric (NP) involvement and 313 SLE patients without neuropsychiatric symptoms (SLE) without anti-phospholipid antibodies were judged eligible for this sub-analysis. Among ''generic'' risk factors, hypertension did emerged as more frequently represented in SLE than in NPSLE patients (31,7% vs 19%; p=0,020) and a higher prevalence of familiarity for psychiatric disorders resulted significantly more represented in NPSLE than in SLE (9,3% vs 2,5%; p=0,010). Considering NP events, a more frequent occurrence of hypertension was observed among patients without NP events (33,2%) whilst a cumulative dose of GC >10 grams was significantly more frequently recorded in patients with SLE-related than in patients with SLE-unrelated NP events and in those without NP events at all. The stepwise logistic regression analysis applied to this subset of patients showed that age at disease onset (OR =0,970; 95% CI 0,949 to 0,992) and a cumulative dose of glucocorticosteroids <10 grams (OR =0,426; 95% CI 0,230 to 0,789) were independently and inversely related to NP involvement. When the occurrence of SLE-related NP events was assumed as the dependent variable, again, the same two variables were retained as inversely and independently related. Conclusions: aPLA, LA and APS have been confirmed as the most relevant risk factor associated with NP involvement (especially focal) in the original cohort of 959 SLE patients. In the sub-analysis performed in 413 patients negative for aPL (aCL, LA and anti-b2GP1) or APS, other risk factor such as familiarity for psychiatric disorders, cumulative dose of GC >10 grams and a younger age at disease onset did emerge as related to the NP involvement. Conversely hypertension did prove to be as more frequently represented in SLE than in NPSLE patients.
Risk factors and co-morbidities associated with neuro-psychiatric involvement in SLE: a sub-analysis in 413 patiens without antiphosphiolipid antibodies
Gremese E;
2011-01-01
Abstract
Background: Neuropsychiatric (NP) involvement represents a major cause of morbidity and mortality in Systemic Lupus Erythematosus (SLE) patients and appears strongly related to the presence of antiphospholipid antibodies. Objectives: To evaluate, by a retrospective cross-sectional case-control multicentric study from 8 italian rheumatology institutions, the distribution of a number of risk factors and co-morbidities potentially related to central nervous system involvement in a large cohort of SLE patients without antiphospholipid antibodies. Methods: From a large Italian multicentric cohort of patients with SLE a sub-analysis including only those patients negative for aPL (aCL, LA and anti-b2GP1) was performed comparing the distribution of a number of ''generic'' (i.e. not strictly SLE related: hypertension, diabetes, atherosclerosis, dyslipidemia, smoking, hyperhomocysteinemia, glucocorticosteroids, ecc.) and ''specific'' (i.e. disease-related: anti-Sm and anti Ro/SSA antibodies, cutaneous vasculitis, Sjogren's syndrome, ecc) risk factors. Results: From the entire cohort of 959 SLE patients, 100 SLE patients with neuropsychiatric (NP) involvement and 313 SLE patients without neuropsychiatric symptoms (SLE) without anti-phospholipid antibodies were judged eligible for this sub-analysis. Among ''generic'' risk factors, hypertension did emerged as more frequently represented in SLE than in NPSLE patients (31,7% vs 19%; p=0,020) and a higher prevalence of familiarity for psychiatric disorders resulted significantly more represented in NPSLE than in SLE (9,3% vs 2,5%; p=0,010). Considering NP events, a more frequent occurrence of hypertension was observed among patients without NP events (33,2%) whilst a cumulative dose of GC >10 grams was significantly more frequently recorded in patients with SLE-related than in patients with SLE-unrelated NP events and in those without NP events at all. The stepwise logistic regression analysis applied to this subset of patients showed that age at disease onset (OR =0,970; 95% CI 0,949 to 0,992) and a cumulative dose of glucocorticosteroids <10 grams (OR =0,426; 95% CI 0,230 to 0,789) were independently and inversely related to NP involvement. When the occurrence of SLE-related NP events was assumed as the dependent variable, again, the same two variables were retained as inversely and independently related. Conclusions: aPLA, LA and APS have been confirmed as the most relevant risk factor associated with NP involvement (especially focal) in the original cohort of 959 SLE patients. In the sub-analysis performed in 413 patients negative for aPL (aCL, LA and anti-b2GP1) or APS, other risk factor such as familiarity for psychiatric disorders, cumulative dose of GC >10 grams and a younger age at disease onset did emerge as related to the NP involvement. Conversely hypertension did prove to be as more frequently represented in SLE than in NPSLE patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.