title: Prospective study of neuropsychiatric events in systemic lupus erythematosus.
abstract: OBJECTIVE
  To prospectively examine neuropsychiatric (NP) events and their association with health related quality of life (HRQOL) over time in patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  In an observational cohort study from a single academic center, NP events and their attribution were identified at enrollment and at annual assessments for up to 7 years. NP events were characterized using the American College of Rheumatology case definitions; other variables were global SLE disease activity and cumulative organ damage. The outcomes of NP events were recorded and self-report HRQOL was measured with the mental (MCS) and physical (PCS) component summary scores of the Medical Outcomes Study Short Form-36.
  
  
  RESULTS
  There were 209 patients, 88% female and 92% Caucasian, with a mean (standard deviation) age of 43.7 (13.8) years. Followup was available in 175/209 (84%) patients. There were 299 NP events in 132/209 (63%) patients over a mean followup of 3.6 (2.5) years. Thirty-one percent of NP events in 54 patients were attributed to SLE. Multivariate analysis indicated lower MCS scores in patients with NP events compared to those without events (p < 0.001) regardless of attribution. The group means for PCS scores were significantly lower in patients with NP events (p < 0.001) regardless of attribution. There was no association between HRQOL and cumulative organ damage, nor between NP events and the progression of organ damage.
  
  
  CONCLUSIONS
  The association of lower HRQOL with NP events over time, which is independent of progression in cumulative organ damage, emphasizes the persistent negative effect of NP events in the lives of patients with SLE.
authors.affiliation: Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia B3H 4K4, Canada. john.hanly@cdha.nshealth.ca
authors.forename: John G
authors.initials: JG
authors.lastname: Hanly
authors.forename: Li
authors.initials: L
authors.lastname: Su
authors.forename: Vern
authors.initials: V
authors.lastname: Farewell
authors.forename: Grace
authors.initials: G
authors.lastname: McCurdy
authors.forename: Lisa
authors.initials: L
authors.lastname: Fougere
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000523:psychology*; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life