title: Depressive symptoms are associated with tumor necrosis factor alpha in systemic lupus erythematosus.
abstract: BACKGROUND
  Tumor necrosis factor alpha (TNF-α) is deeply related to pathogenesis of neurodevelopmental disorders, especially depression. The aim of this study was to explore potential relationships between sera TNF-α levels and mood and anxiety disorders in systemic lupus erythematosus (SLE) patients.
  
  
  METHODS
  We included 153 consecutive SLE patients (women 148; median age 30; range 10-62) and 40 (women 37; mean age 28.5; range 12-59) age- and sex-matched healthy controls. Mood and anxiety disorders were determined through Beck Depression and Beck Anxiety Inventory. SLE patients were further assessed for clinical and laboratory SLE manifestations. TNF-α levels were measured by enzyme-linked immunosorbent assay using commercial kits.
  
  
  RESULTS
  Depressive symptoms were identified in 70 (45.7 %) SLE patients and in 10 (25 %) healthy controls (p < 0.001). Anxiety symptoms were identified in 93 (60.7 %) SLE patients and in 16 controls (40 %) (p < 0.001). Sera TNF-α levels were increased in SLE patients with depressive symptoms (p < 0.001) and with anxiety symptoms (p = 0.014). A direct correlation between the severity of depressive symptoms and sera TNF-α levels (r = 0.22; p = 0.003) was observed. TNF-α levels were significantly increased in patients with active disease (p = 0.012). In addition, we observed a correlation between sera TNF-α levels and disease activity (r = 0.28; p = 0.008). In the multivariate analysis, sera TNF-α levels were independently associated with depressive symptoms (t = 3.28; 95 % CI 1.08-2.2; p = 0.002).
  
  
  CONCLUSIONS
  Sera TNF-α levels are increased in SLE patients with mood and anxiety disorders. In SLE, sera TNF-α levels are independently associated with mood disorders. The etiology of mood disorders is still debated in SLE, but our findings suggest the presence of immunological basis for depression in SLE.
authors.affiliation: Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. maripostal@hotmail.com.
authors.forename: Mariana
authors.initials: M
authors.lastname: Postal
authors.affiliation: Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. aline_atl@yahoo.com.br.
authors.forename: Aline Tamires
authors.initials: AT
authors.lastname: Lapa
authors.affiliation: Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. nailu.angelica@gmail.com.
authors.forename: Nailú Angélica
authors.initials: NA
authors.lastname: Sinicato
authors.affiliation: Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. karina_gfh@hotmail.com.
authors.forename: Karina
authors.initials: K
authors.lastname: de Oliveira Peliçari
authors.affiliation: Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. gutoperes7@gmail.com.
authors.forename: Fernando Augusto
authors.initials: FA
authors.lastname: Peres
authors.affiliation: Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. lilian@fcm.unicamp.br.
authors.forename: Lilian Tereza Lavras
authors.initials: LT
authors.lastname: Costallat
authors.affiliation: Department of Sport Sciences, Faculty of Physical Education State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
authors.forename: Paula Teixeira
authors.initials: PT
authors.lastname: Fernandes
authors.affiliation: Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. marini@hc.unicamp.br.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marini
authors.affiliation: Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. appenzellersimone@yahoo.com.|Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. appenzellersimone@yahoo.com.
authors.forename: Simone
authors.initials: S
authors.lastname: Appenzeller
mesh_terms: D000293:Adolescent; D000328:Adult; D000974:Antibodies, Antinuclear / Q000378:metabolism; D002648:Child; D016207:Cytokines / Q000378:metabolism; D003863:Depression / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood* / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha