%0 Journal Article
%@ 2326-5205
%A Hanly, JG
%A Li, Q
%A Su, L
%A Urowitz, MB
%A Gordon, C
%A Bae, S-C
%A Romero-Diaz, J
%A Sanchez-Guerrero, J
%A Bernatsky, S
%A Clarke, AE
%A Wallace, DJ
%A Isenberg, DA
%A Rahman, A
%A Merrill, JT
%A Fortin, PR
%A Gladman, DD
%A Bruce, IN
%A Petri, M
%A Ginzler, EM
%A Dooley, MA
%A Steinsson, K
%A Ramsey-Goldman, R
%A Zoma, AA
%A Manzi, S
%A Nived, O
%A Jonsen, A
%A Khamashta, MA
%A Alarcón, GS
%A van Vollenhoven, RF
%A Aranow, C
%A Mackay, M
%A Ruiz-Irastorza, G
%A Ramos-Casals, M
%A Sam Lim, S
%A Inanc, M
%A Kalunian, KC
%A Jacobsen, S
%A Peschken, CA
%A Kamen, DL
%A Askanase, A
%A Theriault, C
%A Farewell, V
%D 2019
%F discovery:10061149
%J Arthritis & Rheumatology
%K Outcome, Psychosis, Systemic lupus erythematosus
%N 2
%P 281-289
%T Psychosis in Systemic Lupus Erythematosus
%U https://discovery.ucl.ac.uk/id/eprint/10061149/
%V 71
%X OBJECTIVE: To determine, in a multi-ethnic/racial, prospective SLE inception cohort, the frequency, attribution, clinical and autoantibody associations with lupus psychosis and the short and long-term outcome as assessed by physicians and patients. METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. SLE disease activity 2000, SLICC/ACR damage index and SF-36 scores were collected. Time to event and linear regressions were used as appropriate. RESULTS: Of 1,826 SLE patients, 88.8% were female, 48.8% Caucasian. The mean±SD age was 35.1±13.3 years, disease duration 5.6±4.2 months and follow-up 7.4±4.5 years. There were 31 psychotic events in 28/1,826 (1.53%) patients and most [(26/28; 93%)] had a single event. In the majority of patients [20/25; (80%)] and events [28/31; (90%)] psychosis was attributed to SLE, usually within 3 years of SLE diagnosis. Positive associations [hazard ratio and 95% confidence interval [HR (95%CI)] with lupus psychosis were prior SLE NP events [3.59, (1.16, 11.14), male sex [3.0, (1.20, 7.50)], younger age at SLE diagnosis [(per 10 years younger), 1.45 (1.01, 2.07)] and African ancestry [4.59 (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 outlook is good for most patients, though careful follow-up is required. This article is protected by copyright. All rights reserved.
%Z Copyright © 2018 The Authors. Arthritis & Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.