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Abstract Number: 1259

Cognitive Dysfunction In Childhood Systemic Lupus Erythematosus: Comparison Of Different Classification Criteria

Bruna Bellini1, Cleonice de Souza1, Mariana Postal1, Nailu A. Sinicato1, Roberto Marini2, Paula T Fernandes3 and Simone Appenzeller4, 1Medicine, State University of Campinas, Campinas, Brazil, 2State University of Campinas, Campinas, Brazil, 3Faculty of Physical Education, State University of Campinas, Campinas, Brazil, 4Medicine, Faculty of Medical Science, State University of Campinas Unicamp, São Paulo, Brazil

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Cognitive dysfunction and systemic lupus erythematosus (SLE)

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Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects II: Pediatric Systemic Lupus Erythematosus, Pediatric Vasculitis and Pediatric Myositis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Cognitive deficits are frequently observed in systemic lupus erythematosus (SLE), in both adult and childhood (cSLE) onset. However there are several different cutoff levels to define cognitive impairment in cSLE. Objective: To determine the frequency of cognitive impairment in cSLE according to different classification criteria and to identify the relationship with clinical, immunological and treatment features of the disease. 

Methods: We performed a cross-sectional study including patients with age of disease onset ≤ 18 years and controls matched for gender, age and education. We performed a battery of tests, selected from the American College of Rheumatology battery. Fifteen subtests were used to evaluate 13 cognitive functions. Cognitive dysfunction were categorized by 3 different classification criteria with different cutoff scores: criteria 1 (dysfunction=score ≤-2 SD below the standardized mean in 1 cognitive function, or scores between -1 and -2 SD below the mean in 2 or more functions); criteria 2 (dysfunction = score ≤-2 SD below the normative mean in 1 or more cognitive functions and cognitive decline = scores between -1.5 and -1.9 SD below published norms in 1 or more functions); criteria 3 (dysfunction = score ≤-1.5 SD below the normative mean). Anxiety and depression were assessed by the Beck scales. SLE patients were further assessed for clinical and laboratory SLE manifestations, disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] and current drug exposures. Total dose of corticosteroids and other immunosuppressant medications used since the onset of disease were calculated by data obtained by careful review of the medical charts. Statistical analysis was performed using SPSS and significance level was 5% (p<0.05). 

Results: 64 cSLE patients  (92.2% women; mean age 16.56±4.43 years; range  8-29) and 71 controls (78.9% women; mean age 16.37±5.21 years; range 8-29) were included. Active disease (SLEDAI ≥3)  was identified in 28 (43.8%) cSLE patients. Following criteria 1 definition, 33 (51.6%) cSLE patients and 26 (36.6%) controls had cognitive dysfunction (p=0.08). Following criteria 2 definition 22 (34.4%) cSLE and 14 (19.7%) controls had cognitive dysfunction and 7 (10.9%) cSLE and 2 (2.8%) controls had cognitive decline (p=0.013). Applying criteria 3, 14 (21.9%) cSLE and 13 (18.3%) controls had cognitive dysfunction (p=0.61).  There was no relation between cognitive impairment following any criteria and education, age of disease onset, disease duration, cumulative damage, presence of antiphospholipid, ds-DNA, Ro and Sm antibodies, chloroquine, corticosteroids and other immunosuppressive therapy. 

Conclusion:

Cognitive impairment is frequently observed in cSLE and in healthy age and sex matched controls. However, changes in criteria for defining cognitive dysfunction led to significant changes in frequency rates. Criteria 2 had the best discrimination between cSLE and controls in our cohort. Further studies should determine the ideal cutoff in cSLE.


Disclosure:

B. Bellini,

FAPESP,

2;

C. de Souza,

FAPESP,

9;

M. Postal,

FAPESP,

9;

N. A. Sinicato,

FAPESP,

9;

R. Marini,
None;

P. T. Fernandes,
None;

S. Appenzeller,

FAPESP and CNPq,

2.

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