Can Autoantibodies Predict Neuropsychiatric Events in Lupus?
Can Autoantibodies Predict Neuropsychiatric Events in Lupus?
Hanly JG, Urowitz MB, Su L,et al
Ann Rheum Dis. 2011;70:1726-1732
Neuropsychiatric events in systemic lupus erythematosus (SLE) can be unpredictable as well as devastating. Prospectively established evidence-based methodologies that could help predict NP events would be of benefit in the management of patients with SLE.
Methods. To accomplish this goal, Hanly and associates used the resources of the Systemic Lupus International Collaborating Clinics network to prospectively identify factors that predicted NP events in 1047 patients with SLE.
Patients who fulfilled the American College of Rheumatology (ACR) classification criteria for SLE were evaluated for NP events as defined by the ACR's case definitions. NP events were further attributed to SLE on the basis of 2 established sets of decision rules (model A, most stringent; model B, least stringent) that accounted for factors such as prevalence of NP events in normal populations. Multiple demographic and clinical factors, and blood-based biomarkers were assessed, including antinuclear antibodies, extractable nuclear antigens, antiphospholipid antibodies, antiribosomal P antibodies, and antibody to a glutamate receptor that has been implicated in NP events in SLE. The relationship between these factors and prospectively occurring NP events was examined.
Results.The mean duration of SLE for these 1047 patients was approximately 5 months at enrollment. During a mean prospective follow-up time of 3.6 years, the number of assessments varied. With respect to NP events, 495/1047 patients (47%) had ≥ 1 NP event (total 917 events) during the evaluation period. The most common NP events were headache (52%), mood disorders (14%), and seizures (6%). The percentage of al 917 NP events attributed to SLE after application of the decision rules ranged from approximately 15% (model A) to 28% (model B), and affected approximately 10% of all patients (model A) and approximately 17% of all patients (model B). Overall, no significant association between autoantibodies and the first occurrence of an NP event was found. However, in subset analyses, the investigators did find significant associations between antiribosomal P antibodies and future episodes of psychosis (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.2-12.5), and between an abnormal lupus anticoagulant with stroke or sinus thrombosis (OR 2.5; 95% CI, 1.08-5.94). Of note, for these NP events (psychosis or stroke), model B was used to define the event as it related to SLE.
Autoantibodies as Biomarkers for the Prediction of Neuropsychiatric Events in Systemic Lupus Erythematosus
Hanly JG, Urowitz MB, Su L,et al
Ann Rheum Dis. 2011;70:1726-1732
Study Summary
Neuropsychiatric events in systemic lupus erythematosus (SLE) can be unpredictable as well as devastating. Prospectively established evidence-based methodologies that could help predict NP events would be of benefit in the management of patients with SLE.
Methods. To accomplish this goal, Hanly and associates used the resources of the Systemic Lupus International Collaborating Clinics network to prospectively identify factors that predicted NP events in 1047 patients with SLE.
Patients who fulfilled the American College of Rheumatology (ACR) classification criteria for SLE were evaluated for NP events as defined by the ACR's case definitions. NP events were further attributed to SLE on the basis of 2 established sets of decision rules (model A, most stringent; model B, least stringent) that accounted for factors such as prevalence of NP events in normal populations. Multiple demographic and clinical factors, and blood-based biomarkers were assessed, including antinuclear antibodies, extractable nuclear antigens, antiphospholipid antibodies, antiribosomal P antibodies, and antibody to a glutamate receptor that has been implicated in NP events in SLE. The relationship between these factors and prospectively occurring NP events was examined.
Results.The mean duration of SLE for these 1047 patients was approximately 5 months at enrollment. During a mean prospective follow-up time of 3.6 years, the number of assessments varied. With respect to NP events, 495/1047 patients (47%) had ≥ 1 NP event (total 917 events) during the evaluation period. The most common NP events were headache (52%), mood disorders (14%), and seizures (6%). The percentage of al 917 NP events attributed to SLE after application of the decision rules ranged from approximately 15% (model A) to 28% (model B), and affected approximately 10% of all patients (model A) and approximately 17% of all patients (model B). Overall, no significant association between autoantibodies and the first occurrence of an NP event was found. However, in subset analyses, the investigators did find significant associations between antiribosomal P antibodies and future episodes of psychosis (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.2-12.5), and between an abnormal lupus anticoagulant with stroke or sinus thrombosis (OR 2.5; 95% CI, 1.08-5.94). Of note, for these NP events (psychosis or stroke), model B was used to define the event as it related to SLE.
