Milena Mimica1, Ignacio Barra2, Rocío Ormeño3, Patricia Flores4, Jorge Calderón4, Oslando Padilla5, Marcela Bravo-Zehnder1, Alfonso González1,6,7, Loreto Massardo8. 1. Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Carmen Sylva 2444, Providencia, 7510156, Santiago, Chile. 2. Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 3. Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 4. Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 5. Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 6. Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile. 7. Fundación Ciencia y Vida, Santiago, Chile. 8. Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Carmen Sylva 2444, Providencia, 7510156, Santiago, Chile. loreto.massardo@uss.cl.
Abstract
OBJECTIVE: Central nervous system disease occurs in over 20% of patients with systemic lupus erythematosus (SLE) resulting in major morbidity and damage. Cognitive dysfunction is common in SLE, but the cause remains uncertain and treatment options are limited. This study explores the influence of clinical, neuropsychological factors and anti-neuronal antibodies on lupus damage accrual. METHOD: A prospective cohort with 99 SLE patients recruited between 2008 and 2013 and followed up in 2016 was established. Baseline evaluations were depression (MINI-Plus), cognitive function evaluating attention, visuospatial memory and executive functions, and anti-neuronal antibodies. Activity index (SLEDAI-2K) and SLICC/ACR Damage Index (SDI) were assessed at baseline and last follow-up. RESULTS: At baseline, median (interquartile range) age was 36.0 years (27.0-45.0), disease duration 3.7 years (0.4-12.4), SLEDAI-2K 6.0 (3.0-12.0), and SDI score 1.0 (0-1.0). Major depression was present in 23%, cognitive deficit in 18%, and received immunomodulators in 36%. Anti-dsDNA/N-methyl-D-aspartate receptor antibodies were present in 19%, anti-ribosomal P in 12%, and anti-neuronal surface P antigen (NSPA) in 5%. After a median follow-up of 55 months (interquartile range 39-78), 11% had damage accrual. In a multivariate analysis, baseline SDI, SLEDAI-2K, and immunomodulators use were associated with final damage, whereas SLEDAI-2K and immunomodulator use were also associated with accrual damage. Models including anti-NSPA showed impact on final and accrual damage. Cognitive deficit, depression, and other autoantibodies were not predictors. CONCLUSIONS: Disease activity and immunomodulator use associate with lupus damage. Of the anti-neuronal antibodies examined, anti-NSPA emerged as a potential poor prognostic factor, probably related to severe SLE onset requiring elevated corticosteroid doses. Key Points • Anti-NSPA may be a worse prognostic factor in SLE. • Other neuropsychological factors do not influence damage.
OBJECTIVE:Central nervous system disease occurs in over 20% of patients with systemic lupus erythematosus (SLE) resulting in major morbidity and damage. Cognitive dysfunction is common in SLE, but the cause remains uncertain and treatment options are limited. This study explores the influence of clinical, neuropsychological factors and anti-neuronal antibodies on lupus damage accrual. METHOD: A prospective cohort with 99 SLEpatients recruited between 2008 and 2013 and followed up in 2016 was established. Baseline evaluations were depression (MINI-Plus), cognitive function evaluating attention, visuospatial memory and executive functions, and anti-neuronal antibodies. Activity index (SLEDAI-2K) and SLICC/ACR Damage Index (SDI) were assessed at baseline and last follow-up. RESULTS: At baseline, median (interquartile range) age was 36.0 years (27.0-45.0), disease duration 3.7 years (0.4-12.4), SLEDAI-2K 6.0 (3.0-12.0), and SDI score 1.0 (0-1.0). Major depression was present in 23%, cognitive deficit in 18%, and received immunomodulators in 36%. Anti-dsDNA/N-methyl-D-aspartate receptor antibodies were present in 19%, anti-ribosomal P in 12%, and anti-neuronal surface P antigen (NSPA) in 5%. After a median follow-up of 55 months (interquartile range 39-78), 11% had damage accrual. In a multivariate analysis, baseline SDI, SLEDAI-2K, and immunomodulators use were associated with final damage, whereas SLEDAI-2K and immunomodulator use were also associated with accrual damage. Models including anti-NSPA showed impact on final and accrual damage. Cognitive deficit, depression, and other autoantibodies were not predictors. CONCLUSIONS: Disease activity and immunomodulator use associate with lupus damage. Of the anti-neuronal antibodies examined, anti-NSPA emerged as a potential poor prognostic factor, probably related to severe SLE onset requiring elevated corticosteroid doses. Key Points • Anti-NSPA may be a worse prognostic factor in SLE. • Other neuropsychological factors do not influence damage.
Authors: J Calderón; P Flores; J M Aguirre; G Valdivia; O Padilla; I Barra; L Scoriels; S Herrera; A González; L Massardo Journal: Scand J Rheumatol Date: 2016-10-05 Impact factor: 3.641
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Authors: Soledad Matus; Patricia V Burgos; Marcela Bravo-Zehnder; Regine Kraft; Omar H Porras; Paula Farías; L Felipe Barros; Fernando Torrealba; Loreto Massardo; Sergio Jacobelli; Alfonso González Journal: J Exp Med Date: 2007-12-03 Impact factor: 14.307
Authors: Ian N Bruce; Aidan G O'Keeffe; Vern Farewell; John G Hanly; Susan Manzi; Li Su; Dafna D Gladman; Sang-Cheol Bae; Jorge Sanchez-Guerrero; Juanita Romero-Diaz; Caroline Gordon; Daniel J Wallace; Ann E Clarke; Sasha Bernatsky; Ellen M Ginzler; David A Isenberg; Anisur Rahman; Joan T Merrill; Graciela S Alarcón; Barri J Fessler; Paul R Fortin; Michelle Petri; Kristjan Steinsson; Mary Anne Dooley; Munther A Khamashta; Rosalind Ramsey-Goldman; Asad A Zoma; Gunnar K Sturfelt; Ola Nived; Cynthia Aranow; Meggan Mackay; Manuel Ramos-Casals; Ronald F van Vollenhoven; Kenneth C Kalunian; Guillermo Ruiz-Irastorza; Sam Lim; Diane L Kamen; Christine A Peschken; Murat Inanc; Murray B Urowitz Journal: Ann Rheum Dis Date: 2014-05-16 Impact factor: 19.103