Psychosis in Systemic Lupus Erythematosus: results from an international, inception cohort study

Research output: Contribution to journalArticlepeer-review


  • John G. Hanly
  • Qiuju Li
  • Li Su
  • Murray B. Urowitz
  • 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

Colleges, School and Institutes

External organisations

  • University of Cambridge
  • Toronto Western Hospital and University of Toronto
  • Hanyang University
  • Instituto Nacional de Ciencias Medicas y Nutrición
  • McGill University
  • University of Calgary
  • University College London
  • Oklahoma Medical Research Foundation
  • Université Laval
  • Manchester University Hospitals NHS Foundation Trust
  • Johns Hopkins University
  • SUNY Downstate Medical Center
  • North Carolina State University
  • University Hospital
  • Northwestern University
  • Lanarkshire Center for Rheumatology Hairmyres Hospital East KilbrideScotlandUK
  • Lupus Center of Excellence Allegheny Health Network
  • Lunds Universitet
  • King's College Hospital NHS Foundation Trust
  • University of Alabama
  • Karolinska Institutet
  • Feinstein Institute for Medical Research
  • University of the Basque Country
  • Josep Font Autoimmune Diseases Laboratory IDIBAPS Department of Autoimmune Diseases Hospital Clínic BarcelonaSpain
  • Istanbul University
  • UCSD School of Medicine La JollaCAUSA
  • Copenhagen University Hospitals
  • University of Manitoba
  • University of South Carolina
  • Hospital for Joint Diseases NYU Seligman Center for Advanced Therapeutics New York NY
  • Dalhousie University
  • University of California
  • Emory University


Objective: To determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (SLE), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short‐ and long‐term outcomes as assessed by physicians and patients.

Methods: Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (SF‐36) were recorded. Time to event and linear regressions were used as appropriate.

Results: Of 1,826 SLE patients, 88.8% were female and 48.8% were Caucasian. The mean ± SD age was 35.1 ± 13.3 years, the mean ± SD disease duration was 5.6 ± 4.2 months, and the mean ± SD follow‐up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [HRs] and 95% confidence intervals [95% CIs]) with lupus psychosis were previous SLE NP events (HR 3.59 [95% CI 1.16–11.14]), male sex (HR 3.0 [95% CI 1.20–7.50]), younger age at SLE diagnosis (per 10 years) (HR 1.45 [95% CI 1.01–2.07]), and African ancestry (HR 4.59 [95% CI 1.79–11.76]). By physician assessment, most psychotic events resolved by the second annual visit following onset, in parallel with an improvement in patient‐reported SF‐36 summary and subscale scores.

Conclusion: Psychosis is an infrequent manifestation of NPSLE. Generally, it occurs early after SLE onset and has a significant negative impact on health status. As determined by patient and physician report, the short‐ and long‐term outlooks are good for most patients, although careful follow‐up is required.


Original languageEnglish
Number of pages9
JournalArthritis and Rheumatology
Early online date30 Oct 2018
Publication statusE-pub ahead of print - 30 Oct 2018