Department of Rheumatology, Leiden University Medical Center, Leiden.
Department of Rheumatology, Maasstad Hospital, Rotterdam.
Rheumatology (Oxford). 2017 Oct 1;56(10):1676-1683. doi: 10.1093/rheumatology/kex019.
To determine the contribution of reassessment in the attribution process of neuropsychiatric (NP) events to SLE or other aetiologies in a large, prospective and multidisciplinary assessed NPSLE cohort and to compare these results with other available attribution models for NP events occurring in SLE.
Three hundred and four consecutive SLE patients presenting NP events were evaluated. All subjects underwent standardized multidisciplinary medical, neuropsychological, laboratory and radiological examination on the inclusion and reassessment dates. Diagnosis was always established by multidisciplinary consensus. The final diagnosis after reassessment also took into account disease course and response to treatment. These data were compared with currently available attribution models for NP events in SLE.
A total of 463 NP events were established. After reassessment, attribution to SLE was discordant in 64 (13.8%) NP events when compared with the first visit. We show that 14.5% of NP events previously attributed to SLE reclassified as non-NPSLE. In 86.4% of these patients immunosuppressive therapy was started after the first visit. When reassessment and available attribution models were compared, NPSLE cases overlapped considerably. Although specificity was high for all comparisons (0.81-0.95), an important variation in sensitivity (0.39-0.83) and agreement estimates (κ = 0.29-0.68) was observed. The Italian algorithm showed the highest sensitivity and specificity (>0.80) and moderate agreement (0.59-0.64).
In clinical practice NP events presenting in SLE are too often attributed to an immune-mediated origin. Multidisciplinary reassessment avoids misclassification in NPSLE. Multidisciplinary reassessment is the reference standard in NP events presenting in SLE and cannot be replaced by available attribution models.
在一个大型的、前瞻性的和多学科评估的 NPSLE 队列中，确定重新评估在 SLE 或其他病因引起的神经精神（NP）事件归因过程中的作用，并将这些结果与其他可用于评估 SLE 中发生的 NP 事件的归因模型进行比较。
评估了 304 例连续的出现 NP 事件的 SLE 患者。所有患者在纳入和重新评估时均接受了标准化的多学科医学、神经心理学、实验室和影像学检查。所有诊断均由多学科共识确定。重新评估后的最终诊断还考虑了疾病过程和治疗反应。这些数据与目前 SLE 中 NP 事件的归因模型进行了比较。
共确定了 463 例 NP 事件。与首次就诊相比，重新评估后，64 例（13.8%）NP 事件的归因与 SLE 不一致。我们表明，14.5%的先前归因于 SLE 的 NP 事件重新分类为非 NPSLE。在这些患者中，86.4%的患者在首次就诊后开始接受免疫抑制治疗。当重新评估和可用的归因模型进行比较时，NPSLE 病例重叠相当多。尽管所有比较的特异性都很高（0.81-0.95），但观察到敏感性（0.39-0.83）和一致性估计值（κ=0.29-0.68）的重要差异。意大利算法显示出最高的敏感性和特异性（>0.80）和中等的一致性（0.59-0.64）。
在临床实践中，SLE 中出现的 NP 事件往往归因于免疫介导的原因。多学科重新评估可避免 NPSLE 的分类错误。多学科重新评估是 SLE 中出现的 NP 事件的参考标准，不能被现有的归因模型所取代。
