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Psychosis in systemic lupus erythematosus (SLE): 40-year experience of a specialist centre

Abrol, E; Coutinho, E; Chou, M; Hart, M; Vincent, A; Howard, R; Zandi, MS; (2021) Psychosis in systemic lupus erythematosus (SLE): 40-year experience of a specialist centre. Rheumatology , 60 (12) pp. 5620-5629. 10.1093/rheumatology/keab160. Green open access

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Abstract

OBJECTIVES: The long-term outcome of psychosis in association with Systemic Lupus Erythematosus (SLE) has been insufficiently characterised. We used a specialist centre cohort of patients with SLE and psychosis to investigate their clinical outcome and phenotypic and laboratory characteristics. METHODS: Retrospective cohort study of 709 SLE patients seen at a specialist centre between January 1978 and November 2018. Clinical, biochemical and immunological characteristics (Bonferroni corrected), and serum neuronal surface antibody profile using novel cell-based assays, were compared between patients with and without psychosis. RESULTS: Eighteen (18/709, 2.5%) patients developed lupus psychosis over a mean±SD of 17.5 ± 11.0 years follow-up. Psychosis fully remitted in 66.7% (12/18) with a combination of antipsychotic (in 28.9%) and immunosuppressive therapy (methylprednisolone 72.2%, cyclophosphamide 55.6%, Rituximab 16.7%, plasma exchange 27.8%, prednisolone 50%). Patients who developed lupus psychosis may be more likely to have anti-RNP antibodies (50.0% vs 26.5%) and less likely to have anti-cardiolipin antibodies (5.6% vs 30.0%), but this was not significant in our small sample. Neuronal surface autoantibody tests found GABABR autoantibodies in 3/10 (30.0%) lupus psychosis patients compared with only 3/27 (11.1%) in age- and sex-matched SLE controls using fixed cell-based assays (p= 0.114). However, GABABR antibodies were not replicated using a live cell-based assay. NMDAR-antibodies were not detected with fixed or live cell assays in any samples. CONCLUSION: Lupus psychosis is rare but treatable. In this rare sample of eighteen patients from a 40 year cohort, no significant biomarker was found, but some preliminary associations warrant further exploration in a larger multicentre analysis.

Type: Article
Title: Psychosis in systemic lupus erythematosus (SLE): 40-year experience of a specialist centre
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/rheumatology/keab160
Publisher version: https://doi.org/10.1093/rheumatology/keab160
Language: English
Additional information: Copyright © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: SLE, autoimmune psychosis, lupus, psychosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation
URI: https://discovery.ucl.ac.uk/id/eprint/10123775
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