Mental health problems frequently overlooked in lupus

A new study has found that patients with systemic lupus erythematosus (SLE) and neuropsychiatric syndromes report more symptoms of depression and cognitive dysfunction compared to patients with rheumatoid arthritis (RA) and similar mental-health problems. Yet lupus patients do not report significantly poorer health-related quality of life. In a paper appearing in the August 2005 issue of the Journal of Rheumatology, researchers say this points to non-disease-specific causes of neuropsychiatric disorders that clinicians are going to need to watch for.

“The overall prevalence of neuropsychiatric syndromes in our sample of systemic lupus erythematosus patients was 28%, and the most frequent were headache, mood disorder, and anxiety disorders,” the team reports. “In RA patients, who were well matched for demographic, clinical, and treatment variables, the overall prevalence of neuropsychiatric syndromes was even higher at 47%, and the most common events were similar to those seen in lupus.”Led by Dr John Hanly (Dalhousie University, Halifax, NS), the researchers explain that the non-disease-specific expression of neuropsychiatric syndromes in lupus has implications for the management of individual patients as well as for the design of future studies to examine pathogenesis and treatment.Supported by a grant from the Canadian Institutes of Health Research, Hanly and colleagues looked at 53 lupus patients matched with 53 patients with RA. All participants were attending ambulatory clinics in a single academic medical center and fulfilled the American College of Rheumatology (ACR) classification criteria for either SLE or RA. Using the ACR nomenclature and case definitions for 19 neuropsychiatric syndromes, the researchers determined the cumulative number of manifestations. They measured depression and anxiety with hospital anxiety and depression scales and assessed symptoms of cognitive dysfunction with the cognitive symptoms inventory. The group evaluated health-related quality of life with the Short Form-36 and studied fatigue using the 10-point Likert scale.More than half of the neuropsychiatric events occurred before lupus diagnosisThe investigators observed no significant differences in self-reported health-related quality of life, fatigue, anxiety, depression, and cognitive symptoms between the two groups. They found that the proportion of patients with cumulative neuropsychiatric events was higher in RA than in lupus and the occurrence of multiple events in individual patients was comparable in both groups (53% in lupus and 48% in RA, p= 0.75). More than half of the neuropsychiatric events occurred before the diagnosis of lupus or RA. Hanly and colleagues report that many events were common to lupus and RA. They write, “RA has a number of similarities to lupus with regard to clinical features and treatment, but with certain exceptions such as upper cervical cord compression and peripheral neuropathies, RA does not cause nervous system disease.” They continue that the finding that anxiety, headache, and mood disorders were of comparable frequency in lupus and RA patients was therefore of “considerable interest.” The researchers explain that although this observation does not exclude the possibility that different pathogenic mechanisms may be responsible for these manifestations in lupus and RA, it does suggest that lupus patients are not more likely to experience these symptoms than patients with other chronic rheumatic diseases.The group concludes that while neuropsychiatric manifestations in lupus and RA patients were not associated with poorer health-related quality of life on a generic profile measure, they were associated with greater psychological distress in patients with lupus. “This emphasizes the importance of recognizing the mental-health issues of these patients and of symptomatic therapy.” They point out that the diagnosis of neuropsychiatric problems in lupus is complicated because its occurrence in individual patients may be the result of a primary immunopathogenic mechanism or an alternative disease.(Source: Hanly JG, Fisk JD, McCurdy G, et al. Neuropsychiatric syndromes in patients with systemic lupus erythematosus and rheumatoid arthritis. J Rheumatol 2005; 32:1459-1460: Joint and Bone: Allison Gandey: August 2005.)