Background/Purpose: Neuropsychiatric systemic lupus erythematosus (NPSLE) involves a wide range of peripheral and central neuropsychiatric manifestations. Depression is one of those and is very common in patients with SLE. The aim of this study was to determine if depression increases the risk of lupus flare in our patient population at Temple University Hospital, which is predominantly African American, and also to determine if therapy for Depression impacts SLE flares.

Methods:  Data were collected from patients with SLE who fulfilled at least 4 SLICC criteria, at each clinic encounter from January 2013 to December 2015. Patients’ demographics, medical, surgical and social history, medication list and laboratory results were included. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinic (SLICC) Damage Index (SDI) were also extracted and analyzed as they were incorporated into our Epic Care EHR and routinely extracted to facilitate disease monitoring.

Results:  Out of 209 patients present in the lupus cohort, 38 patients had a diagnosis of depression in their medical history. On review of these patient charts, 32 patients were included (6 excluded for having only 2 visits). 34 patients with diagnoses of lupus randomly selected from our cohort and without depression acted as control. The majority of our patients with concurrent lupus and depression were in the 40^th and 50^th decade of life. Only 62.5% (20/32) of patients were on antidepressants. SLEDAI analysis revealed that 62.5% (20/32) patients had at least a lupus flare and 75% (9/12) of these patients were not on any antidepressants, whereas those on antidepressants 55%(11/20) had lupus flare. The two groups were not statistically different (chi-square, p= 0.083). Interestingly lupus patients with depression compared to patients without depression, had statistically more flares (chi-square, p= 0.027). On our analysis though higher SLICC scores were common in lupus patients with depression, it did not reach significance (chi-square, p= 0.392). Also on comparing other comorbidities including HTN, diabetes, infections and social factors such as smoking, these were more common in lupus with depression (chi-square, p=0.041).

Conclusion:  Prevalence of depression is high in SLE patients. We confirmed that Lupus patients with depression have significantly more flare compared to those without depression. Although it has been shown that the risk of lupus flare is high in those untreated for depression, in our cohort there was no statistical significance compared to those not on antidepressants. Other factors besides treatment that played a significant role in our cohort was presence of comorbid illnesses. Depression might be considered an independent risk factor for Lupus flares.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-depression-on-sle-flares/