Date: Sunday, November 8, 2020
Session Type: Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Little is known about mortality in patients with systemic lupus erythematosus (SLE) presenting with neuropsychiatric (NP) symptoms. We aimed to evaluate all-cause and cause-specific mortality in patients with SLE and NP symptoms.
Methods: All patients with the clinical diagnosis of SLE visiting the tertiary referral NPSLE clinic of the LUMC between 2007-2018 were included in this study. Patients were classified as NPSLE if NP symptoms were attributed to SLE (either at current assessment or in the past) and immunosuppressive or anticoagulant therapy was initiated, otherwise patients were classified as minor or non-NPSLE (minor/non-NPSLE). Municipal registries were checked for current status. Electronical medical files were studied for clinical characteristics and cause of death. Standardized mortality ratios (SMRs) and 95% confidence intervals were calculated using data from the general Dutch population. In addition, a rate ratio (RR) was calculated using direct standardization to compare mortality in NPSLE with minor/non-NPSLE patients.
Results: 351 patients with NP symptoms and the clinical diagnosis of SLE were included, of which 149 patients were classified as NPSLE (42.5%). Compared with the general population, mortality was increased five times in NPSLE (SMR 5.0, 95% CI: 2.6-8.5) and nearly four times in minor/non-NPSLE patients (SMR 3.7, 95% CI: 2.2-6.0), as shown in Table 1. Risk of death due to cardiovascular disease (CVD) was increased in minor/non-NPSLE patients (SMR 6.2, 95% CI: 2.0-14.6) and an increased risk of death to infections was present in both NPSLE and minor/non-NPSLE patients (SMR 29.9, 95% CI: 3.5 – 105 and SMR 91.3 95% CI: 18.8 – 266) respectively. However, mortality did not differ between NPSLE and minor/non-NPSLE patients (RR 1.0, 95% CI: 0.5 – 2.0).
Conclusion: Mortality was increased in both NPSLE and minor/non-NPSLE patients in comparison with the general population, but there was no difference in mortality between NPSLE and minor/non-NPSLE patients. This is different than expected and might imply that major NPSLE does not influence prognosis when recognized and treated.
To cite this abstract in AMA style:Monahan R, Fronczek R, Eikenboom J, Middelkoop H, Beaart-van de Voorde L, Terwindt G, van der Wee N, Rosendaal F, Huizinga T, Kloppenburg M, Steup-Beekman M. Mortality in Patients with Systemic Lupus Erythematosus and Neuropsychiatric Symptoms [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/mortality-in-patients-with-systemic-lupus-erythematosus-and-neuropsychiatric-symptoms/. Accessed September 20, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-in-patients-with-systemic-lupus-erythematosus-and-neuropsychiatric-symptoms/