Background/Purpose: Patients with systemic lupus erythematosus (SLE) frequently report cognitive impairment as well as depressive symptoms and significant pain. However, depression criteria and SLE symptoms may overlap (e.g., difficulty concentrating, low energy), and may both be exacerbated by pain. The purpose of this study is to evaluate the associations of patient-reported pain and cognitive symptoms in SLE patients with co-morbid depressive symptoms. Exploration of the relationships between these variables can better inform clinicians regarding treatment of individuals with SLE and depression.

Methods: Ninety patients with SLE (1997 Criteria) diagnosed with major depressive disorder or subsyndromal depression completed a baseline assessment for the NIH-NIAMS funded study, Reducing Depressive Symptoms in SLE (R01 AR 57338). Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CESD) scale. Self-reported ratings of pain and cognitive symptoms were collected with the PROMIS^®Pain Interference short form and Cognitive Symptoms Inventory (CSI), respectively. Associations of baseline CESD total score and subscales, CSI and subscales, and Pain were evaluated cross-sectionally using Pearson’s r.  

Results: Participants’ average age was 49 (+/- 12) years, 92% were females, and 23% were African American or other minority race.  48% had household income of < $50,000.  The mean CESD score was 29.8 (SD=6).  Baseline scores on the three variables of interest all met assumptions for normality and homoscedasticity. CESD total score was significantly associated with both total CSI (r = .38, p<.001) and pain (r = .38, p<.001). Specifically, the CESD somatic subscale had the strongest relationship with the attention/concentration subscale on the CSI (r = .4, p<.001). Similarly, the CESD somatic subscale was the only subscale that significantly correlated with pain (r = .36, p<.001), as the depression, positive affect, and interpersonal subscales were not significantly correlated with pain scores. Total cognitive symptoms score had a moderate positive correlation with pain scores, (r = .52, p<.001). Specifically, all of the CSI subscales were significantly correlated with PROMIS pain scores: attention/concentration (r = .49, p<.001); pattern recognition/activity management (r = .44, p<.001); immediate memory (r = .41, p<.001); and executive functioning (r = .37, p<.001).

Conclusion: In SLE patients with co-morbid depression, somatic features of depression (e.g., restless sleep, appetite disturbance) were most strongly associated with cognitive symptoms and pain, in contrast to sadness and interpersonal features of depression. Interestingly, correlation analyses indicated that the strongest relationship lies between pain and cognitive symptoms, specifically attention and concentration. The importance of pain, perceived cognitive disruption, and depressive symptoms should not be underestimated in evaluating and treating SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-reported-cognitive-impairment-pain-and-depressive-symptoms-in-patients-with-systemic-lupus-erythematosus-and-comorbid-depression/