Background/Purpose: Neuropsychiatric symptoms (NPS) are observed in SLE with a variable prevalence depending on patient selection and assessment methods. In 2010, a 27-item questionnaire was developed to identify NPS in SLE (1); in the present study we aim to compare the capability to detect NPS by means of this questionnaire and routine clinical assessment in SLE.

Methods: The questionnaire was administered to consecutive SLE patients from two European Countries as a physicians’ administered tool in one cohort (PhQ) and  a self-administered questionnaire in the other (PaQ). On the same day the routine clinical assessment was performed by a physician expert in SLE management blinded to the questionnaire result. The concordance level of NP symptoms as reported by questionnaires and clinical evaluation were calculated. The questionnaire was considered positive in presence of at least one symptom recorded.

Results:

Overall, 137 patients were enrolled; the PhQ was administered to 70 patients (96% female, mean age at enrolment 42.3±12 years, disease duration 12.5±8.6 years) while the PaQ to 67 patients (92% female, mean age at enrolment 47±13 years, disease duration 14±9 years). Previous NP involvement was present in 25% of patients in PhQ cohort  and in 21% in PaQ cohort. According to the clinical records and irrespectively from their attribution, NPS were reported in 23 patients (32%) in the PhQ cohort, and in 23 (34.3%) in the PaQ cohort; overall, there were neurologic symptoms in 15% and psychiatric symptoms in 14% of cases. According to questionnaires, at least one NPS was captured in 61 patients (87%) of the PhQ cohort and 62 (92%) in PaQ cohort. In the PhQ cohort, among the 61 patients with at least one symptom as captured by the questionnaire PhQ, 20 (32.7%) have also NPS recorded in the clinical chart; in all the 8 patients with negative questionnaire, no NPS were recorded in the clinical chart (agreement p=0.057). Similarly,  among the 62 patients with positive PaQ, 20 (29.8%) have also NPS recorded in the clinical chart (agreement p=0.07).Cognitive impairment, depression and anxiety were the most overlooked symptoms in the clinical charts.

Conclusion: These data demonstrated that some NPS can be overlooked by the physician during routine clinical assessment. Although the clinical significance of these observations are under evaluation, this screening questionnaire can be a useful aid, for identifying patients with NPS requiring further evaluation.

1. Mosca M, et al. The development of a simple questionnaire to screen patients with SLE for the presence of neuropsychiatric symptoms in routine clinical practice. Lupus. 2011 Apr;20(5):485-92.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-burden-of-neuropsychiatric-symptoms-in-systemic-lupus-erythematosus-physicians-and-patients-perspectives/