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Arthritis Rheumatol. 2019 Aug 7. doi: 10.1002/art.41070. [Epub ahead of print]

Peripheral nervous system disease in Systemic Lupus Erythematosus: Results from an international, inception cohort study.

Author information

1
Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada.
2
MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
3
Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada.
4
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
5
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
6
Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
7
Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
8
Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
9
Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
10
Center for Rheumatology, Department of Medicine, University College London, UK.
11
Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
12
Division of Rheumatology, Department of Medicine, CHU de Québec, Université Laval, Quebec City, Canada.
13
Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center Manchester, UK.
14
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
15
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
16
Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.
17
Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland.
18
Northwestern University and Feinberg School of Medicine, Chicago, IL, USA.
19
Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
20
Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA.
21
Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
22
Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, UK, London, UK.
23
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
24
Department of Medicine, Unit of Rheumatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
25
Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, Amsterdam, Holland.
26
Feinstein Institute for Medical Research, Manhasset, NY, USA.
27
Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
28
Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
29
Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA.
30
Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
31
UCSD School of Medicine, La Jolla, CA, USA.
32
Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
33
University of Manitoba, Winnipeg, Manitoba, Canada.
34
Medical University of South Carolina, Charleston, South Carolina, USA.
35
Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics, New York, NY.
36
Department of Medicine, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

OBJECTIVES:

In a multi-ethnic/racial, prospective SLE inception cohort, to determine the frequency, clinical characteristics, associations and outcomes in different types of peripheral nervous system (PNS) disease.

METHODS:

Patients were evaluated annually for 19 neuropsychiatric (NP) events including seven types of PNS disease. SLE disease activity, organ damage, autoantibodies, patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate.

RESULTS:

Of 1,827 SLE patients, 88.8% were female, 48.8% Caucasian. The mean±SD age was 35.1±13.3 years, disease duration at enrollment 5.6±4.2 months and follow-up 7.6±4.6 years. There were 161 PNS events in 139/1,827 (7.6%) patients. The predominant events were peripheral neuropathy [66/161 (41.0%)], mononeuropathy [44/161 (27.3%)] and cranial neuropathy [39/161 (24.2%)] and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with prior history of neuropathy, older age at SLE diagnosis, higher SLEDAI-2K scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower SF-36 physical and mental component summary scores versus patients without NP events. By physician assessment, the majority of neuropathies resolved or improved over time and this was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy.

CONCLUSION:

PNS disease is an important component of total NPSLE and has a significant negative impact on health related quality of life. The outcome is favourable for most patients, but we noted several factors associated with longer time to resolution. This article is protected by copyright. All rights reserved.

KEYWORDS:

Neuropathy; Outcome; Systemic lupus erythematosus

PMID:
31390162
DOI:
10.1002/art.41070

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