Centre for Prognosis Studies in Rheumatic Diseases and Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2012 Jun;64(6):833-7. doi: 10.1002/acr.21624. Epub 2012 Jan 30.
Neuropsychiatric (NP) manifestations attributable to active disease affect up to 30% of individuals with systemic lupus erythematosus (SLE). The short-term impact of NP events includes increased organ damage, fatigue, and mortality, and lower health-related quality of life. We investigated the impact of NP events attributable to active SLE at presentation on long-term disease activity, organ damage, and health-related quality of life.
Seventy-two NP cases and 144 matched controls from the University of Toronto Lupus Cohort, enrolled between 1970 and 2005, were included in the study. NP cases had at least 1 NP event attributable to active SLE at the first clinic visit. Controls did not have NP events at the first clinic visit and were matched to cases on age, sex, disease duration, and decade. Paired case-control analyses were performed on measures of disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000), disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and health-related quality of life (Short Form 36) at 1 year, 3 years, and 5 years after the first clinic visit.
NP cases showed greater disease activity than controls at the first clinic visit (P < 0.0001) and greater cumulative organ damage at 1-year followup (P = 0.01). No statistically significant differences were found on 3-year or 5-year outcomes. Mean scores showed a decreasing trend of disease activity, increasing organ damage, and persistently low quality of life for both cases and controls.
This study shows that early NP events due to active SLE are not major contributors to long-term disease activity, accumulation of damage, or health-related quality of life. The long-term prognosis and patterns of disease in SLE patients with early NP events are similar to those of SLE patients without these events.
由活动期疾病引起的神经精神（NP）表现影响多达 30%的系统性红斑狼疮（SLE）患者。NP 事件的短期影响包括增加器官损害、疲劳和死亡率，以及降低健康相关生活质量。我们研究了在首次就诊时归因于活动期 SLE 的 NP 事件对长期疾病活动、器官损害和健康相关生活质量的影响。
本研究纳入了多伦多大学狼疮队列中的 72 例 NP 病例和 144 例匹配对照，这些病例均于 1970 年至 2005 年间入组。NP 病例在首次就诊时至少有 1 次归因于活动期 SLE 的 NP 事件。对照组在首次就诊时无 NP 事件，并与病例按年龄、性别、疾病持续时间和十年进行匹配。对首次就诊后 1 年、3 年和 5 年的疾病活动（SLE 疾病活动指数 2000）、疾病损害（SLE 国际合作临床/美国风湿病学会损害指数）和健康相关生活质量（SF-36）进行了配对病例对照分析。
NP 病例在首次就诊时的疾病活动度高于对照组（P<0.0001），且在 1 年随访时的累积器官损害程度更高（P=0.01）。在 3 年或 5 年的随访中未发现统计学差异。病例和对照组的疾病活动度、器官损害程度和健康相关生活质量评分均呈下降趋势。
本研究表明，由活动期 SLE 引起的早期 NP 事件并非导致长期疾病活动度、损害累积或健康相关生活质量下降的主要因素。早期 NP 事件的 SLE 患者的长期预后和疾病模式与无这些事件的 SLE 患者相似。
