title: Long-term outcome of early neuropsychiatric events due to active disease in systemic lupus erythematosus.
abstract: OBJECTIVE
  Neuropsychiatric (NP) manifestations attributable to active disease affect up to 30% of individuals with systemic lupus erythematosus (SLE). The short-term impact of NP events includes increased organ damage, fatigue, and mortality, and lower health-related quality of life. We investigated the impact of NP events attributable to active SLE at presentation on long-term disease activity, organ damage, and health-related quality of life.
  
  
  METHODS
  Seventy-two NP cases and 144 matched controls from the University of Toronto Lupus Cohort, enrolled between 1970 and 2005, were included in the study. NP cases had at least 1 NP event attributable to active SLE at the first clinic visit. Controls did not have NP events at the first clinic visit and were matched to cases on age, sex, disease duration, and decade. Paired case-control analyses were performed on measures of disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000), disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and health-related quality of life (Short Form 36) at 1 year, 3 years, and 5 years after the first clinic visit.
  
  
  RESULTS
  NP cases showed greater disease activity than controls at the first clinic visit (P < 0.0001) and greater cumulative organ damage at 1-year followup (P = 0.01). No statistically significant differences were found on 3-year or 5-year outcomes. Mean scores showed a decreasing trend of disease activity, increasing organ damage, and persistently low quality of life for both cases and controls.
  
  
  CONCLUSIONS
  This study shows that early NP events due to active SLE are not major contributors to long-term disease activity, accumulation of damage, or health-related quality of life. The long-term prognosis and patterns of disease in SLE patients with early NP events are similar to those of SLE patients without these events.
authors.affiliation: Centre for Prognosis Studies in Rheumatic Diseases and Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Wang
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
authors.forename: Dominique
authors.initials: D
authors.lastname: Ibañez
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index