Mood disorders in systemic lupus erythematosus: Results from an international, inception cohort study.

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

    Research output: Contribution to journalArticlepeer-review

    Abstract

    OBJECTIVE: To determine the frequency, clinical and autoantibody associations and outcome of mood disorders in a multi-ethnic/racial, prospective, inception cohort of SLE patients. METHODS: Patients were assessed annually for mood disorders (4 types as per DSM-IV) and 18 other neuropsychiatric (NP) events. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 subscale, mental (MCS) and physical (PCS) component summary scores were collected. Time to event, linear and ordinal regressions and multi-state models were used as appropriate. RESULTS: Of 1,827 SLE patients, 88.9% were female, 48.9% Caucasian, mean±SD age 35.1±13.3 years, disease duration 5.6±4.8 months and follow-up 4.73±3.45 years. Over the study 863 (47.2%) patients had 1,627 NP events. Mood disorders occurred in 232/1827 (12.7%) patients and 98/256 (38.3%) events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95%CI=[15.1%,20.2%]). There was a greater risk of mood disorder in patients with concurrent NP events (p≤0.01) and lower risk with Asian race/ethnicity (p=0.01) and immunosuppressive drugs (p=0.003). Mood disorders were associated with lower mental health subscale and MCS scores but not with SLEDAI-2K, SDI scores or lupus autoantibodies. Antidepressants were used in 168/232 (72.4%) patients with depression.126/256 (49.2%) mood disorders resolved in 117/232 (50.4%) patients. CONCLUSION: Mood disorders, the second most frequent NP event in SLE patients, have a negative impact on HRQoL and improve over time. The lack of association with global SLE disease activity, cumulative organ damage and lupus autoantibodies emphasize their multifactorial etiology and a role for non-lupus specific therapies. This article is protected by copyright. All rights reserved.
    Original languageEnglish
    Pages (from-to)1837-47
    JournalArthritis & rheumatology (Hoboken, N.J.)
    Volume67
    Issue number7
    DOIs
    Publication statusPublished - 16 Mar 2015

    Keywords

    • Inception cohort
    • Mood disorders
    • Outcomes research
    • Systemic lupus erythematosus

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