Pego-Reigosa J M, Isenberg D A
Centre for Rheumatology Research, University College of London Division of Medicine, London, UK.
Rheumatology (Oxford). 2008 Oct;47(10):1498-502. doi: 10.1093/rheumatology/ken260. Epub 2008 Jul 25.
To determine the prevalence, characteristics and long-term outcome of psychosis due to SLE defined according to the ACR nomenclature for neuropsychiatric (NP) syndromes.
All the patients who strictly fulfilled the ACR definition for psychosis due to lupus were identified within the 485 patients of our lupus cohort and retrospectively evaluated.
Psychosis due to lupus was diagnosed in 11 (2.3%) patients. Lupus psychosis presented as the initial presentation of SLE in 60% of the patients and within the first year of the disease in 80% of the cases. All the patients developed psychotic symptoms within the context of multi-systemic lupus activity, with 90% of them having cutaneous involvement. Psychosis activity in our patients was associated with biological markers of lupus activity in 90% of the cases. The aPLS were observed in 10% of the cases. Seventy percent of our patients showed complete resolution of psychotic symptoms after a mean follow-up of 155 months. Long-lasting remissions were seen in all those patients. Chronic mild psychotic symptoms were observed in 30% of our patients.
Psychosis due to lupus is an uncommon event that usually occurs early in the course of the disease and is associated with other clinical and biological features of SLE. Long-term outcome appears to be favourable after intensive immunosuppressive treatment. This report highlights the need for prospective multi-centre studies to improve our knowledge and to help establish guidelines for the treatment of this rare complication of lupus.
根据美国风湿病学会（ACR）神经精神（NP）综合征命名法确定系统性红斑狼疮（SLE）所致精神病的患病率、特征及长期预后。
在我们的狼疮队列中的485例患者中，识别出所有严格符合狼疮所致精神病ACR定义的患者，并进行回顾性评估。
11例（2.3%）患者被诊断为狼疮所致精神病。60%的患者狼疮性精神病为SLE的首发表现，80%的病例在疾病的第一年内出现。所有患者均在多系统狼疮活动的背景下出现精神症状，其中90%有皮肤受累。90%的病例中，我们患者的精神病活动与狼疮活动的生物学标志物相关。10%的病例观察到抗磷脂综合征（aPLS）。平均随访155个月后，70%的患者精神症状完全缓解。所有这些患者均出现持久缓解。30%的患者观察到慢性轻度精神症状。
狼疮所致精神病是一种罕见事件，通常在疾病早期发生，并与SLE的其他临床和生物学特征相关。强化免疫抑制治疗后长期预后似乎良好。本报告强调需要进行前瞻性多中心研究，以提高我们的认识，并有助于建立治疗这种罕见狼疮并发症的指南。
