Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach,Annals of the Rheumatic Diseases

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Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach
Annals of the Rheumatic Diseases ( IF 20.3 ) Pub Date : 2020-01-08 , DOI: 10.1136/annrheumdis-2019-216150
John G Hanly ₁ , Murray B Urowitz ₂ , Caroline Gordon ₃ , Sang-Cheol Bae ₄ , Juanita Romero-Diaz ₅ , Jorge Sanchez-Guerrero ₂ , Sasha Bernatsky ₆ , Ann E Clarke ₇ , Daniel J Wallace ₈ , David A Isenberg ₉ , Anisur Rahman ₉ , Joan T Merrill ₁₀ , Paul R Fortin ₁₁ , Dafna D Gladman ₂ , Ian N Bruce ₁₂ , Michelle Petri ₁₃ , Ellen M Ginzler ₁₄ , Mary Anne Dooley ₁₅ , Rosalind Ramsey-Goldman ₁₆ , Susan Manzi ₁₇ , Andreas Jönsen ₁₈ , Graciela S Alarcón ₁₉ , Ronald F van Vollenhoven ₂₀ , Cynthia Aranow ₂₁ , Meggan Mackay ₂₁ , Guillermo Ruiz-Irastorza ₂₂ , Sam Lim ₂₃ , Murat Inanc ₂₄ , Kenneth C Kalunian ₂₅ , Søren Jacobsen ₂₆ , Christine A Peschken ₂₇ , Diane L Kamen ₂₈ , Anca Askanase ₂₉ , Vernon Farewell ₃₀

Affiliation

Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth ll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico.
Divisions of Rheumatology and Clinical Epidemiology, Department of medicine, McGill University, Montreal, Quebec, Canada.
Divisions of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Centre for Rheumatology Research, Department of Medicine, University College, London, UK.
Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
Division of Rheumatology, Department of Medicine, CHU de Québec, Université Laval, Quebec City, Quebec, Canada.
Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA.
Northwestern University and Feinberg School of Medicine, Chicago, IL, USA.
Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA.
Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Rheumatology and Clinical Immunology, University Medical Centres, Amsterdam, The Netherlands.
Feinstein Institute for Medical Research, Manhasset, NY, USA.
Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
Emory University, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA.
Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
UCSD School of Medicine, La Jolla, CA, USA.
Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
University of Manitoba, Winnipeg, Manitoba, Canada.
Medical University of South Carolina, Charleston, South Carolina, USA.
Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA.
MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.

Objectives Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. Methods Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. Results NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001). Conclusions NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.

中文翻译：

系统性红斑狼疮的神经精神事件：使用多态模型方法对国际初始队列的结果进行纵向分析

目标使用可逆的多状态模型，我们前瞻性地检查了神经精神 (NP) 事件的归因、结果和与健康相关生活质量 (HRQoL) 的关联，在系统性红斑狼疮 (SLE) 患者的国际初始队列中。方法对归因于 SLE 和非 SLE 原因的 19 次 NP 事件、医生对结果的确定和患者 HRQoL（简写 (SF)-36 评分）进行年度评估。事件时间分析和多状态建模检查了 NP 状态之间的发生、复发和转变。结果 NP 事件发生在 955/1827 (52.3%) 名患者中，592/1910 (31.0%) 次独特事件归因于 SLE。在随访的前 2 年，与此后相比，SLE NP 事件的相对风险 (95% CI) 为 6.16 (4.96, 7.66)，非 SLE 事件为 4.66 (4.01, 5.43)。初始评估时没有 SLE NP 事件的患者在 10 年内无事件发生的概率为 74%。对于非 SLE NP 事件，估计值为 48%。大多数 NP 事件在 10 年内得到解决，但因 SLE 发生 NP 事件的患者 (16%) 与无 NPSLE 事件的患者 (6%) 相比死亡率更高，而非 SLE NP 事件患者的死亡率相当 (7 %) 与没有非 SLE 事件的患者 (6%) 相比。与没有 NP 事件和解决 NP 状态的患者相比，有 NP 事件的患者的 SF-36 总分较低（p<0.001）。结论 NP 事件在 SLE 诊断前后最常发生。尽管大多数事件都解决了，但它们与 HRQoL 降低和死亡率过高有关。多状态建模非常适合评估 SLE 中的 NP 事件。

更新日期：2020-01-08

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