Session Type: Abstract Submissions (ACR)
Background/Purpose: To determine differences in cognitive functions in childhood-onset systemic lupus erythematosus (cSLE).
Methods: We performed a cross-sectional study including patients with age of onset of disease ≤ 18 years and controls matched for gender, age and education level. Cognitive evaluation was performed in all participants using Wechsler Intelligence Scale for children (WISC-III) and Wechsler Intelligence Scale for adults (WAIS), according to age. The subjects were divided in two groups: WISC (≤16 years and 9 months) and WAIS (>16 years and 10 months) according to the age at evaluation. Anxiety and depression were assessed by the Beck scales in all subjects. 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.
Results: In the WISC group we included 35 cSLE (mean age=13.43 ± 2.10 years, range 8-17 years; mean age of disease onset of 11.23 ± 3.21; mean disease duration=2.80 ± 2.63 years) and 38 controls (mean age=12.32±2.83). In the WAIS group a total of 29 cSLE (mean age=20.34 ± 3.42 years, range 18-29; mean age of disease onset of 13.76 ± 4.08; mean disease duration=6.59 ± 4.72 years) and 35 controls (mean age 21.03±2.86) were included. cSLE patients in the WISC group had lower scores in speed processing (z-score= -0.33±1vs 0.29±1.27; p<0.05 ) and mental flexibility (zscore= -0.12±0.7vs -0.60±0.51; p<0.05) when compared to controls. Age at disease onset correlated with cognitive flexibility (r=0,352; p=0,038), anxiety with visuographic memory (r=0.43; p=0,016) and depression with visual perception (τ=-0,261; p=0,044). Lower scores in visual recognition and naming was observed in patients with positive anticardiolipin (p=0.022) and anti-Sm (p=0.046) antibodies. Positive lupus anticoagulant (LA) was associated with lower scores in verbal fluency (p=0.019) and motor dexterity (p=0,046).
cSLE patients in the WAIS group had significant lower scores in semantic memory (z-score -0.22±0,.80 vs 0.46±0.94), speed processing (z-score -0.02±0.78 vs 0,41±0,93) and motor dexterity (z-score=0.40±0,82 vs 0,66±0,91) when compared to controls. Lower scores of visual recognition and naming (p=0.015) and sustained attention (p=0.02) were observed in WAIS cSLE patients with anxiety. Lower temporal reasoning scores were observed in cSLE patients with positive lupus anticoagulant (p=0,013). No association of current and cummulative corticosteroid dose and other medication, disease activity, damage scores and cognitive performance in either group was observed.
Conclusion: According to age, different aspects of cognition are affected in cSLE. Overall, cSLE patients had lower scores in speed processing than controls. Mood disorders, antiphospholipid antibodies, and anti-Sm antibodies influence cognitive function in cSLE patients.
C. de Souza,
N. A. Sinicato,
P. T. Fernandes,
FAPESP and CNPq,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cognitive-functions-in-childhood-onset-systemic-lupus-erythematosus/