Background: Neuropsychiatric (NP) involvement represents a major cause of morbidity and mortality in Systemic Lupus Erythematosus (SLE) patients, thus detection of potential risk factors for this complication may be an useful and practical prognostic issue to assess. 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 SLE patients. Methods: 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-phospholipid antibodies, lupus anticoagulant, anti-Sm and anti Ro/SSA antibodies, cutaneous vasculitis, Sjogren's syndrome, ecc) risk factors were checked and their distribution analyzed in 326 SLE patients with neuropsychiatric (NP) involvement (NPSLE) diagnosed according to the 1999 ACR classification criteria, considering their first NP event occurred in a time frame of 10 years, and in 633 ACR 1987 SLE patients without neuropsychiatric symptoms (SLE). Results: Headache, cerebrovascular events, seizures, cognitive dysfunctions and mood disorders were the most frequent NP manifestations observed. NPSLE patients had a major cumulative average number of the investigated factors than controls without NP involvement (4.52 vs 3.73 (p < 0.0001). Antiphospholipids antibodies (APLAs), lupus anticoagulant (LA), Antiphospholipids syndrome (APLS) were significantly more commonly observed among NPSLE while anti Ro/SSA antibodies were more frequently detected among SLE patients without NP involvement. APLAS, LA and cutaneous vasculitis were more frequently detected among patients with focal NP manifestations than in diffuse NPSLE. Smoking habitus, cumulative dose of glucocorticosteroids > 10 gr, and hyperhomocysteinemia were more frequently detected in patients with multiple events. A further analysis excluding patients with antiphospholipid antibodies, revealed that familiar history of psychiatric disorder was more frequent among patients with NP events than in patients without, while hypertension was more frequently detected in the latter. Conclusion: Overall APLAS, LA and APLs did confirm as the most relevant risk factor associated with NP involvement (especially focal) in SLE. Future prospective studies are needed to verify and evaluate the predictive role of these and other potential risk factors such as hyperhomocysteinemia, smoking, cumulative dose of glucocorticosteroids
Risk factors and co-morbidities associated with neuro-psychiatric involvement in SLE: a retrospective multicentric study on a large cohort of 959 italian patients
Gremese E;
2010-01-01
Abstract
Background: Neuropsychiatric (NP) involvement represents a major cause of morbidity and mortality in Systemic Lupus Erythematosus (SLE) patients, thus detection of potential risk factors for this complication may be an useful and practical prognostic issue to assess. 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 SLE patients. Methods: 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-phospholipid antibodies, lupus anticoagulant, anti-Sm and anti Ro/SSA antibodies, cutaneous vasculitis, Sjogren's syndrome, ecc) risk factors were checked and their distribution analyzed in 326 SLE patients with neuropsychiatric (NP) involvement (NPSLE) diagnosed according to the 1999 ACR classification criteria, considering their first NP event occurred in a time frame of 10 years, and in 633 ACR 1987 SLE patients without neuropsychiatric symptoms (SLE). Results: Headache, cerebrovascular events, seizures, cognitive dysfunctions and mood disorders were the most frequent NP manifestations observed. NPSLE patients had a major cumulative average number of the investigated factors than controls without NP involvement (4.52 vs 3.73 (p < 0.0001). Antiphospholipids antibodies (APLAs), lupus anticoagulant (LA), Antiphospholipids syndrome (APLS) were significantly more commonly observed among NPSLE while anti Ro/SSA antibodies were more frequently detected among SLE patients without NP involvement. APLAS, LA and cutaneous vasculitis were more frequently detected among patients with focal NP manifestations than in diffuse NPSLE. Smoking habitus, cumulative dose of glucocorticosteroids > 10 gr, and hyperhomocysteinemia were more frequently detected in patients with multiple events. A further analysis excluding patients with antiphospholipid antibodies, revealed that familiar history of psychiatric disorder was more frequent among patients with NP events than in patients without, while hypertension was more frequently detected in the latter. Conclusion: Overall APLAS, LA and APLs did confirm as the most relevant risk factor associated with NP involvement (especially focal) in SLE. Future prospective studies are needed to verify and evaluate the predictive role of these and other potential risk factors such as hyperhomocysteinemia, smoking, cumulative dose of glucocorticosteroidsI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
