John G Hanly1, Caroline Gordon2, Sang-Cheol Bae3, Juanita Romero-Diaz4, Jorge Sanchez-Guerrero4, Sasha Bernatsky5, Ann E Clarke6, Daniel J Wallace7, David A Isenberg8, Anisur Rahman8, Joan T Merrill9, Paul R Fortin10, Dafna D Gladman11, Murray B Urowitz11, Ian N Bruce12, Michelle Petri13, Ellen M Ginzler14, M A Dooley15, Rosalind Ramsey-Goldman16, Susan Manzi17, Andreas Jonsen18, Graciela S Alarcón19, Ronald F van Vollenhoven20, Cynthia Aranow21, Meggan Mackay21, Guillermo Ruiz-Irastorza22, S Sam Lim23, Murat Inanc24, Kenneth C Kalunian25, Soren Jacobsen26, Christine A Peschken27, Diane L Kamen28, Anca Askanase29, Vernon Farewell30. 1. Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. 2. University of Birmingham, Birmingham, UK. 3. Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. 4. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. 5. McGill University, Montreal, Quebec, Canada. 6. University of Calgary, Calgary, Alberta, Canada. 7. Cedars-Sinai Medical Center and University of California, Los Angeles. 8. University College London, London, UK. 9. Oklahoma Medical Research Foundation, Oklahoma City. 10. Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada. 11. Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Ontario, Canada. 12. Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, NIHR Manchester Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK. 13. Johns Hopkins University School of Medicine, Baltimore, Maryland. 14. State University of New York Downstate Medical Center, Brooklyn. 15. University of North Carolina, Chapel Hill. 16. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 17. Allegheny Health Network, Pittsburgh, Pennsylvania. 18. Lund University, Lund, Sweden. 19. University of Alabama at Birmingham. 20. Amsterdam University Medical Center, Amsterdam, The Netherlands. 21. Feinstein Institute for Medical Research, Manhasset, New York. 22. Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain. 23. Emory University, Atlanta, Georgia. 24. Istanbul University, Istanbul, Turkey. 25. University of California San Diego School of Medicine, La Jolla. 26. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 27. University of Manitoba, Winnipeg, Manitoba, Canada. 28. Medical University of South Carolina, Charleston. 29. NYU Langone Orthopedic Hospital, New York, New York. 30. University of Cambridge, Cambridge, UK.
Abstract
OBJECTIVE: To determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: Upon enrollment and annually thereafter, NP events attributed to SLE and non-SLE causes and physician-determined resolution were documented. Factors potentially associated with the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure. RESULTS: NP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P = 0.028), concurrent non-SLE NP events excluding headache (P < 0.001), active SLE (P = 0.012), and glucocorticoid use (P = 0.008). There was a negative association with Asian race (P = 0.002), postsecondary education (P = 0.001), and treatment with immunosuppressive drugs (P = 0.019) or antimalarial drugs (P = 0.056). For non-SLE NP events excluding headache, there was a positive association with concurrent SLE NP events (P < 0.001) and a negative association with African race (P = 0.012) and Asian race (P < 0.001). NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache, which had comparable resolution rates. For SLE NP events, multivariate analysis revealed that resolution was more common in patients of Asian race (P = 0.006) and for central/focal NP events (P < 0.001). For non-SLE NP events, resolution was more common in patients of African race (P = 0.017) and less common in patients who were older at SLE diagnosis (P < 0.001). CONCLUSION: In a large and long-term study of the occurrence and resolution of NP events in SLE, we identified subgroups with better and worse prognosis. The course of NP events differs greatly depending on their nature and attribution.
OBJECTIVE: To determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: Upon enrollment and annually thereafter, NP events attributed to SLE and non-SLE causes and physician-determined resolution were documented. Factors potentially associated with the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure. RESULTS: NP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P = 0.028), concurrent non-SLE NP events excluding headache (P < 0.001), active SLE (P = 0.012), and glucocorticoid use (P = 0.008). There was a negative association with Asian race (P = 0.002), postsecondary education (P = 0.001), and treatment with immunosuppressive drugs (P = 0.019) or antimalarial drugs (P = 0.056). For non-SLE NP events excluding headache, there was a positive association with concurrent SLE NP events (P < 0.001) and a negative association with African race (P = 0.012) and Asian race (P < 0.001). NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache, which had comparable resolution rates. For SLE NP events, multivariate analysis revealed that resolution was more common in patients of Asian race (P = 0.006) and for central/focal NP events (P < 0.001). For non-SLE NP events, resolution was more common in patients of African race (P = 0.017) and less common in patients who were older at SLE diagnosis (P < 0.001). CONCLUSION: In a large and long-term study of the occurrence and resolution of NP events in SLE, we identified subgroups with better and worse prognosis. The course of NP events differs greatly depending on their nature and attribution.
Authors: D Gladman; E Ginzler; C Goldsmith; P Fortin; M Liang; M Urowitz; P Bacon; S Bombardieri; J Hanly; E Hay; D Isenberg; J Jones; K Kalunian; P Maddison; O Nived; M Petri; M Richter; J Sanchez-Guerrero; M Snaith; G Sturfelt; D Symmons; A Zoma Journal: Arthritis Rheum Date: 1996-03
Authors: Murray B Urowitz; Dafna D Gladman; Vernon Farewell; Jiandong Su; Juanita Romero-Diaz; Sang-Cheol Bae; Paul R Fortin; Jorge Sanchez-Guerrero; Ann Elaine Clarke; Sasha Bernatsky; Caroline Gordon; John G Hanly; Daniel J Wallace; David A Isenberg; Anisur Rahman; Joan T Merrill; Ellen Ginzler; Graciela S Alarcón; W Winn Chatham; Michelle A Petri; Ian N Bruce; Munther A Khamashta; Cynthia Aranow; Mary Anne Dooley; Susan Manzi; Rosalind Ramsey-Goldman; Ola Nived; Andreas Jönsen; Kristján Steinsson; Asad A Zoma; Guillermo Ruiz-Irastorza; S Sam Lim; Kenneth C Kalunian; Murat Ỉnanç; Ronald van Vollenhoven; Manuel Ramos-Casals; Diane L Kamen; Soren Jacobsen; Christine A Peschken; Anca Askanase; Thomas Stoll Journal: Arthritis Rheumatol Date: 2020-08-25 Impact factor: 10.995
Authors: John G Hanly; Murray B Urowitz; Li Su; Caroline Gordon; Sang-Cheol Bae; Jorge Sanchez-Guerrero; Juanita Romero-Diaz; Daniel J Wallace; Ann E Clarke; Em Ginzler; Joan T Merrill; David A Isenberg; Anisur Rahman; M Petri; Paul R Fortin; Dd Gladman; Ian N Bruce; Kristjan Steinsson; Ma Dooley; Munther A Khamashta; Graciela S Alarcón; Barri J Fessler; Rosalind Ramsey-Goldman; Susan Manzi; Asad A Zoma; Gunnar K Sturfelt; Ola Nived; Cynthia Aranow; Meggan Mackay; Manuel Ramos-Casals; Rf van Vollenhoven; Kenneth C Kalunian; Guillermo Ruiz-Irastorza; Sam Lim; Diane L Kamen; Christine A Peschken; Murat Inanc; Chris Theriault; Kara Thompson; Vernon Farewell Journal: Ann Rheum Dis Date: 2012-04-04 Impact factor: 19.103
Authors: J G Hanly; M B Urowitz; J Sanchez-Guerrero; S C Bae; C Gordon; D J Wallace; D Isenberg; G S Alarcón; A Clarke; S Bernatsky; J T Merrill; M Petri; M A Dooley; D Gladman; P R Fortin; K Steinsson; I Bruce; S Manzi; M Khamashta; A Zoma; C Aranow; E Ginzler; R Van Vollenhoven; J Font; G Sturfelt; O Nived; R Ramsey-Goldman; K Kalunian; J Douglas; K Thompson; V Farewell Journal: Arthritis Rheum Date: 2007-01
Authors: John G Hanly; Qiuju Li; Li Su; Murray B Urowitz; Caroline Gordon; Sang-Cheol Bae; Juanita Romero-Diaz; Jorge Sanchez-Guerrero; Sasha Bernatsky; Ann E Clarke; Daniel J Wallace; David A Isenberg; Anisur Rahman; Joan T Merrill; Paul R Fortin; Dafna D Gladman; Ian N Bruce; Michelle Petri; Ellen M Ginzler; M A Dooley; Kristjan Steinsson; Rosalind Ramsey-Goldman; Asad A Zoma; Susan Manzi; Ola Nived; Andreas Jonsen; Munther A Khamashta; Graciela S Alarcón; Ronald F van Vollenhoven; Cynthia Aranow; Meggan Mackay; Guillermo Ruiz-Irastorza; Manuel Ramos-Casals; S Sam Lim; Murat Inanc; Kenneth C Kalunian; Soren Jacobsen; Christine A Peschken; Diane L Kamen; Anca Askanase; Chris Theriault; Vernon Farewell Journal: Arthritis Rheumatol Date: 2019-01-18 Impact factor: 10.995