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

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

57 Citations (Scopus)

Abstract

OBJECTIVE: To determine the frequency, clinical and autoantibody associations and outcome of mood disorders in a multi-ethnic/racial, prospective, inception cohort of SLE patients.

METHODS: Patients were assessed annually for mood disorders (4 types as per DSM-IV) and 18 other neuropsychiatric (NP) events. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 subscale, mental (MCS) and physical (PCS) component summary scores were collected. Time to event, linear and ordinal regressions and multi-state models were used as appropriate.

RESULTS: Of 1,827 SLE patients, 88.9% were female, 48.9% Caucasian, mean±SD age 35.1±13.3 years, disease duration 5.6±4.8 months and follow-up 4.73±3.45 years. Over the study 863 (47.2%) patients had 1,627 NP events. Mood disorders occurred in 232/1827 (12.7%) patients and 98/256 (38.3%) events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95%CI=[15.1%,20.2%]). There was a greater risk of mood disorder in patients with concurrent NP events (p≤0.01) and lower risk with Asian race/ethnicity (p=0.01) and immunosuppressive drugs (p=0.003). Mood disorders were associated with lower mental health subscale and MCS scores but not with SLEDAI-2K, SDI scores or lupus autoantibodies. Antidepressants were used in 168/232 (72.4%) patients with depression.126/256 (49.2%) mood disorders resolved in 117/232 (50.4%) patients.

CONCLUSION: Mood disorders, the second most frequent NP event in SLE patients, have a negative impact on HRQoL and improve over time. The lack of association with global SLE disease activity, cumulative organ damage and lupus autoantibodies emphasize their multifactorial etiology and a role for non-lupus specific therapies. This article is protected by copyright. All rights reserved.

Original language	English
Journal	Arthritis & Rheumatology (Hoboken)
DOIs	https://doi.org/10.1002/art.39111
Publication status	Published - 16 Mar 2015

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10.1002/art.39111

Centre for Musculoskeletal Ageing Research (linked to 18289 & 19482)
Lord, J. (Principal Investigator), Buckley, C. (Co-Investigator), Duda, J. (Co-Investigator), Dunn, W. (Co-Investigator), Miall, C. (Co-Investigator) & Greig, C. (Co-Investigator)
Medical Research Council
1/08/12 → 31/07/17
Project: Research Councils

Cite this

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 & Rheumatology (Hoboken). https://doi.org/10.1002/art.39111

@article{a09d374cf3af4b439f7f0a02e919bbea,

title = "Mood disorders in systemic lupus erythematosus: Results from an international, inception cohort study",

abstract = "OBJECTIVE: To determine the frequency, clinical and autoantibody associations and outcome of mood disorders in a multi-ethnic/racial, prospective, inception cohort of SLE patients.METHODS: Patients were assessed annually for mood disorders (4 types as per DSM-IV) and 18 other neuropsychiatric (NP) events. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 subscale, mental (MCS) and physical (PCS) component summary scores were collected. Time to event, linear and ordinal regressions and multi-state models were used as appropriate.RESULTS: Of 1,827 SLE patients, 88.9% were female, 48.9% Caucasian, mean±SD age 35.1±13.3 years, disease duration 5.6±4.8 months and follow-up 4.73±3.45 years. Over the study 863 (47.2%) patients had 1,627 NP events. Mood disorders occurred in 232/1827 (12.7%) patients and 98/256 (38.3%) events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95%CI=[15.1%,20.2%]). There was a greater risk of mood disorder in patients with concurrent NP events (p≤0.01) and lower risk with Asian race/ethnicity (p=0.01) and immunosuppressive drugs (p=0.003). Mood disorders were associated with lower mental health subscale and MCS scores but not with SLEDAI-2K, SDI scores or lupus autoantibodies. Antidepressants were used in 168/232 (72.4%) patients with depression.126/256 (49.2%) mood disorders resolved in 117/232 (50.4%) patients.CONCLUSION: Mood disorders, the second most frequent NP event in SLE patients, have a negative impact on HRQoL and improve over time. The lack of association with global SLE disease activity, cumulative organ damage and lupus autoantibodies emphasize their multifactorial etiology and a role for non-lupus specific therapies. This article is protected by copyright. All rights reserved.",

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 {Sam Lim}, S 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 = mar,

day = "16",

doi = "10.1002/art.39111",

language = "English",

journal = "Arthritis & Rheumatology (Hoboken)",

issn = "2326-5191",

publisher = "Wiley",

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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, Sam Lim, S, 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 & Rheumatology (Hoboken). https://doi.org/10.1002/art.39111

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 - Sam Lim, S

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 - 2015/3/16

Y1 - 2015/3/16

N2 - OBJECTIVE: To determine the frequency, clinical and autoantibody associations and outcome of mood disorders in a multi-ethnic/racial, prospective, inception cohort of SLE patients.METHODS: Patients were assessed annually for mood disorders (4 types as per DSM-IV) and 18 other neuropsychiatric (NP) events. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 subscale, mental (MCS) and physical (PCS) component summary scores were collected. Time to event, linear and ordinal regressions and multi-state models were used as appropriate.RESULTS: Of 1,827 SLE patients, 88.9% were female, 48.9% Caucasian, mean±SD age 35.1±13.3 years, disease duration 5.6±4.8 months and follow-up 4.73±3.45 years. Over the study 863 (47.2%) patients had 1,627 NP events. Mood disorders occurred in 232/1827 (12.7%) patients and 98/256 (38.3%) events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95%CI=[15.1%,20.2%]). There was a greater risk of mood disorder in patients with concurrent NP events (p≤0.01) and lower risk with Asian race/ethnicity (p=0.01) and immunosuppressive drugs (p=0.003). Mood disorders were associated with lower mental health subscale and MCS scores but not with SLEDAI-2K, SDI scores or lupus autoantibodies. Antidepressants were used in 168/232 (72.4%) patients with depression.126/256 (49.2%) mood disorders resolved in 117/232 (50.4%) patients.CONCLUSION: Mood disorders, the second most frequent NP event in SLE patients, have a negative impact on HRQoL and improve over time. The lack of association with global SLE disease activity, cumulative organ damage and lupus autoantibodies emphasize their multifactorial etiology and a role for non-lupus specific therapies. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: To determine the frequency, clinical and autoantibody associations and outcome of mood disorders in a multi-ethnic/racial, prospective, inception cohort of SLE patients.METHODS: Patients were assessed annually for mood disorders (4 types as per DSM-IV) and 18 other neuropsychiatric (NP) events. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 subscale, mental (MCS) and physical (PCS) component summary scores were collected. Time to event, linear and ordinal regressions and multi-state models were used as appropriate.RESULTS: Of 1,827 SLE patients, 88.9% were female, 48.9% Caucasian, mean±SD age 35.1±13.3 years, disease duration 5.6±4.8 months and follow-up 4.73±3.45 years. Over the study 863 (47.2%) patients had 1,627 NP events. Mood disorders occurred in 232/1827 (12.7%) patients and 98/256 (38.3%) events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95%CI=[15.1%,20.2%]). There was a greater risk of mood disorder in patients with concurrent NP events (p≤0.01) and lower risk with Asian race/ethnicity (p=0.01) and immunosuppressive drugs (p=0.003). Mood disorders were associated with lower mental health subscale and MCS scores but not with SLEDAI-2K, SDI scores or lupus autoantibodies. Antidepressants were used in 168/232 (72.4%) patients with depression.126/256 (49.2%) mood disorders resolved in 117/232 (50.4%) patients.CONCLUSION: Mood disorders, the second most frequent NP event in SLE patients, have a negative impact on HRQoL and improve over time. The lack of association with global SLE disease activity, cumulative organ damage and lupus autoantibodies emphasize their multifactorial etiology and a role for non-lupus specific therapies. This article is protected by copyright. All rights reserved.

U2 - 10.1002/art.39111

DO - 10.1002/art.39111

M3 - Article

C2 - 25778456

SN - 2326-5191

JO - Arthritis & Rheumatology (Hoboken)

JF - Arthritis & Rheumatology (Hoboken)

ER -

Mood disorders in systemic lupus erythematosus: Results from an international, inception cohort study

Abstract

Bibliographical note

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Centre for Musculoskeletal Ageing Research (linked to 18289 & 19482)

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