Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

John G Hanly; Li Su; Murray B Urowitz; Juanita Romero-Diaz; Caroline Gordon; Sang-Cheol Bae; Sasha Bernatsky; Ann E Clarke; Daniel J Wallace; Joan T Merrill; David A Isenberg; Anisur Rahman; Ellen M Ginzler; Michelle Petri; Ian N Bruce; M A Dooley; Paul Fortin; Dafna D Gladman; Jorge Sanchez-Guerrero; Kristjan Steinsson; Rosalind Ramsey-Goldman; Munther A Khamashta; Cynthia Aranow; Graciela S Alarcón; Barri J Fessler; Susan Manzi; Ola Nived; Gunnar K Sturfelt; Asad A Zoma; Ronald F van Vollenhoven; Manuel Ramos-Casals; Guillermo Ruiz-Irastorza; S Sam Lim; Kenneth C Kalunian; Murat Inanc; Diane L Kamen; Christine A Peschken; Soren Jacobsen; Anca Askanase; Chris Theriault; Kara Thompson; Vernon Farewell

doi:10.1002/art.39111

Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

John G Hanly, Li Su, Murray B Urowitz, Juanita Romero-Diaz, Caroline Gordon, Sang-Cheol Bae, Sasha Bernatsky, Ann E Clarke, Daniel J Wallace, Joan T Merrill, David A Isenberg, Anisur Rahman, Ellen M Ginzler, Michelle Petri, Ian N Bruce, M A Dooley, Paul Fortin, Dafna D Gladman, Jorge Sanchez-Guerrero, Kristjan SteinssonRosalind Ramsey-Goldman, Munther A Khamashta, Cynthia Aranow, Graciela S Alarcón, Barri J Fessler, Susan Manzi, Ola Nived, Gunnar K Sturfelt, Asad A Zoma, Ronald F van Vollenhoven, Manuel Ramos-Casals, Guillermo Ruiz-Irastorza, S Sam Lim, Kenneth C Kalunian, Murat Inanc, Diane L Kamen, Christine A Peschken, Soren Jacobsen, Anca Askanase, Chris Theriault, Kara Thompson, Vernon Farewell

Department of Clinical Medicine

57 Citations (Scopus)

Abstract

OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE).

METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate.

RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients.

CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.

Original language	English
Journal	Arthritis & Rheumatism
Volume	67
Issue number	7
Pages (from-to)	1837-47
Number of pages	11
ISSN	0004-3591
DOIs	https://doi.org/10.1002/art.39111
Publication status	Published - 1 Jul 2015

Keywords

Adult
African Continental Ancestry Group
Asian Continental Ancestry Group
Autoantibodies
Cohort Studies
Disease Progression
European Continental Ancestry Group
Female
Hispanic Americans
Humans
Incidence
Internationality
Lupus Erythematosus, Systemic
Male
Middle Aged
Mood Disorders
Prospective Studies
Quality of Life
Regression Analysis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Hanly, J. G., Su, L., Urowitz, M. B., Romero-Diaz, J., Gordon, C., Bae, S-C., Bernatsky, S., Clarke, A. E., Wallace, D. J., Merrill, J. T., Isenberg, D. A., Rahman, A., Ginzler, E. M., Petri, M., Bruce, I. N., Dooley, M. A., Fortin, P., Gladman, D. D., Sanchez-Guerrero, J., ... Farewell, V. (2015). Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis & Rheumatism, 67(7), 1837-47. https://doi.org/10.1002/art.39111

Hanly, JG, Su, L, Urowitz, MB, Romero-Diaz, J, Gordon, C, Bae, S-C, Bernatsky, S, Clarke, AE, Wallace, DJ, Merrill, JT, Isenberg, DA, Rahman, A, Ginzler, EM, Petri, M, Bruce, IN, Dooley, MA, Fortin, P, Gladman, DD, Sanchez-Guerrero, J, Steinsson, K, Ramsey-Goldman, R, Khamashta, MA, Aranow, C, Alarcón, GS, Fessler, BJ, Manzi, S, Nived, O, Sturfelt, GK, Zoma, AA, van Vollenhoven, RF, Ramos-Casals, M, Ruiz-Irastorza, G, Lim, SS, Kalunian, KC, Inanc, M, Kamen, DL, Peschken, CA, Jacobsen, S, Askanase, A, Theriault, C, Thompson, K & Farewell, V 2015, 'Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study', Arthritis & Rheumatism, vol. 67, no. 7, pp. 1837-47. https://doi.org/10.1002/art.39111

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abstract = "OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE).METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate.RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients.CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.",

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author = "Hanly, {John G} and Li Su and Urowitz, {Murray B} and Juanita Romero-Diaz and Caroline Gordon and Sang-Cheol Bae and Sasha Bernatsky and Clarke, {Ann E} and Wallace, {Daniel J} and Merrill, {Joan T} and Isenberg, {David A} and Anisur Rahman and Ginzler, {Ellen M} and Michelle Petri and Bruce, {Ian N} and Dooley, {M A} and Paul Fortin and Gladman, {Dafna D} and Jorge Sanchez-Guerrero and Kristjan Steinsson and Rosalind Ramsey-Goldman and Khamashta, {Munther A} and Cynthia Aranow and Alarc{\'o}n, {Graciela S} and Fessler, {Barri J} and Susan Manzi and Ola Nived and Sturfelt, {Gunnar K} and Zoma, {Asad A} and {van Vollenhoven}, {Ronald F} and Manuel Ramos-Casals and Guillermo Ruiz-Irastorza and Lim, {S Sam} and Kalunian, {Kenneth C} and Murat Inanc and Kamen, {Diane L} and Peschken, {Christine A} and Soren Jacobsen and Anca Askanase and Chris Theriault and Kara Thompson and Vernon Farewell",

note = "{\textcopyright} 2015, American College of Rheumatology.",

year = "2015",

month = jul,

day = "1",

doi = "10.1002/art.39111",

language = "English",

volume = "67",

pages = "1837--47",

journal = "Arthritis & Rheumatology",

issn = "2326-5205",

publisher = "Wiley",

number = "7",

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TY - JOUR

T1 - Mood Disorders in Systemic Lupus Erythematosus

T2 - Results From an International Inception Cohort Study

AU - Hanly, John G

AU - Su, Li

AU - Urowitz, Murray B

AU - Romero-Diaz, Juanita

AU - Gordon, Caroline

AU - Bae, Sang-Cheol

AU - Bernatsky, Sasha

AU - Clarke, Ann E

AU - Wallace, Daniel J

AU - Merrill, Joan T

AU - Isenberg, David A

AU - Rahman, Anisur

AU - Ginzler, Ellen M

AU - Petri, Michelle

AU - Bruce, Ian N

AU - Dooley, M A

AU - Fortin, Paul

AU - Gladman, Dafna D

AU - Sanchez-Guerrero, Jorge

AU - Steinsson, Kristjan

AU - Ramsey-Goldman, Rosalind

AU - Khamashta, Munther A

AU - Aranow, Cynthia

AU - Alarcón, Graciela S

AU - Fessler, Barri J

AU - Manzi, Susan

AU - Nived, Ola

AU - Sturfelt, Gunnar K

AU - Zoma, Asad A

AU - van Vollenhoven, Ronald F

AU - Ramos-Casals, Manuel

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S Sam

AU - Kalunian, Kenneth C

AU - Inanc, Murat

AU - Kamen, Diane L

AU - Peschken, Christine A

AU - Jacobsen, Soren

AU - Askanase, Anca

AU - Theriault, Chris

AU - Thompson, Kara

AU - Farewell, Vernon

PY - 2015/7/1

Y1 - 2015/7/1

N2 - OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE).METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate.RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients.CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.

AB - OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE).METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate.RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients.CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.

KW - Adult

KW - African Continental Ancestry Group

KW - Asian Continental Ancestry Group

KW - Autoantibodies

KW - Cohort Studies

KW - Disease Progression

KW - European Continental Ancestry Group

KW - Female

KW - Hispanic Americans

KW - Humans

KW - Incidence

KW - Internationality

KW - Lupus Erythematosus, Systemic

KW - Male

KW - Middle Aged

KW - Mood Disorders

KW - Prospective Studies

KW - Quality of Life

KW - Regression Analysis

U2 - 10.1002/art.39111

DO - 10.1002/art.39111

M3 - Journal article

C2 - 25778456

SN - 2326-5205

VL - 67

SP - 1837

EP - 1847

JO - Arthritis & Rheumatology

JF - Arthritis & Rheumatology

IS - 7

ER -

Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

Abstract

Keywords

UN SDGs

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