Neuropsychiatric damage in Systemic Lupus Erythematosus: Possible protective role of medications.

Graciela S Alarcón,Jie Zhang,Luis A Gonzáles-Naranjo,Paula I Burgos

doi:10.20453/rnp.v71i1-4.1630

Abstract

Objective: To examine the possible role of medications in the occurrence of neuropsychiatric damage in patientswith systemic lupus erythematosus (SLE). Material and methods: SLE patients from the LUMINA (Lupus inMinorities: Nature vs. Nurture) cohort (ACR criteria, ≥ 16 years of age at enrollment and ≤5 years of diseaseduration) were studied. Time-to-neuropsychiatric damage [defined according with the Systemic Lupus CollaboratingClinics (SLICC) Damage Index (SDI): neurocognitive impairment or psychosis, seizures, cranial or peripheralneuropathy, stroke or surgical resection not due to malignancies and transverse myelitis] was examined by univariableand multivariable Cox regression analyses. Propensity score analyses were done to further determine the possibleprotective role of hydroxychloroquine in neuropsychiatric damage occurrence. Results: Six-hundred and thirtytwopatients were studied. Age, Caucasian ethnicity, disease activity over time, diabetes and abnormal illness-relatedbehaviors were associated with a shorter time-to-the occurrence of neuropsychiatric damage whereas photosensitivity,anemia, Raynaud’s phenomenon, hydroxychloroquine and a medium dose of prednisone were associated with alonger time. Although the direction of the association remained the same by propensity score analyses(hydroxychloroquine), significance was no longer evident. Conclusions: Our data suggest a possible protectiverole of hydroxychloroquine and moderate doses of prednisone in the occurrence of neuropsychiatric damage inpatients with SLE. (Rev. Neuropsiquiatría 2008; 71: 51-57).

Highlights

Involvement of the central nervous system in systemic lupus erythematosus encompasses a number of different manifestations which vary in their characteristics and severity[1,2,3]
The American College of Rheumatology (ACR) has recognized for many years two of them, seizures and psychosis as criteria for the classification of patients with the disease [4,5]; many other neuropsychiatric (NP) manifestations occur in lupus
Texan-Hispanic, African American and Caucasian ethnicities were associated with a shorter time-to-NP damage occurrence as compared to the reference ethnic group (Puerto RicanHispanics); likewise, poverty, higher levels of illnessrelated behaviors and of helplessness were associated with a shorter time-to-the occurrence of NP damage

Summary

Introduction

Involvement of the central nervous system in systemic lupus erythematosus encompasses a number of different manifestations which vary in their characteristics and severity[1,2,3]. The American College of Rheumatology (ACR) has recognized for many years two of them, seizures and psychosis as criteria for the classification of patients with the disease [4,5]; many other neuropsychiatric (NP) manifestations occur in lupus. The ACR has recently recognized this diversity and 17 other syndromes have been described; these manifestations, do not constitute ACR criteria [6]. While some of these syndromes may be transient leaving no permanent sequel or organ damage, others may not as they may be transient and entirely reversible. We were interested in examining the role of antimalarials, namely hydroxychloroquine, in NP damage occurrence given their overall beneficial effects in lupus that we and others have demonstrated, namely preventing relapses or flares of the disease [8,9], preventing the occurrence of damage [10,11]and retarding the occurrence of renal [12] and integument damage [13], and exerting a protective effect on lupus survival [14,15,16]

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