Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital.
Rheumatology (Oxford). 2020 Nov 1;59(11):3211-3220. doi: 10.1093/rheumatology/keaa098.
To study the clinical phenotypes, determined based on cumulative disease activity manifestations, and sociodemographic factors associated with depression and anxiety in SLE.
Patients attending a single centre were assessed for depression and anxiety. SLE clinical phenotypes were based on the organ systems of cumulative 10-year SLE Disease Activity Index 2000 (SLEDAI-2K), prior to visit. Multivariable logistic regression analyses for depression, anxiety, and coexisting anxiety and depression were performed to study associated SLE clinical phenotypes and other factors.
Among 341 patients, the prevalence of anxiety and depression was 34% and 27%, respectively, while 21% had coexisting anxiety and depression. Patients with skin involvement had significantly higher likelihood of anxiety compared with patients with no skin involvement [adjusted odds ratio (aOR) = 1.8; 95% CI: 1.1, 3.0]. Patients with skin involvement also had higher likelihood of having coexisting anxiety and depression (aOR = 2.0, 95% CI: 1.2, 3.9). Patients with musculoskeletal (MSK) (aOR = 1.9; 95% CI: 1.1, 3.5) and skin system (aOR = 1.8; 95% CI: 1.04, 3.2) involvement had higher likelihood of depression compared with patients without skin or musculoskeletal involvement. Employment status and fibromyalgia at the time of the visit, and inception status were significantly associated with anxiety, depression, and coexisting anxiety and depression, respectively.
SLE clinical phenotypes, specifically skin or MSK systems, along with fibromyalgia, employment and shorter disease duration were associated with anxiety or depression. Routine patient screening, especially among patients with shorter disease duration, for these associations may facilitate the diagnosis of these mental health disorders, and allow for more timely diagnosis.
研究基于累积疾病活动表现确定的 SLE 患者抑郁和焦虑的临床表型以及与社会人口学因素的相关性。
评估单一中心就诊的患者的抑郁和焦虑情况。在就诊前，根据累积 10 年 SLE 疾病活动指数 2000（SLEDAI-2K）的器官系统确定 SLE 临床表型。对抑郁、焦虑和同时存在焦虑和抑郁的相关 SLE 临床表型和其他因素进行多变量逻辑回归分析。
在 341 名患者中，焦虑和抑郁的患病率分别为 34%和 27%，同时 21%的患者存在同时存在焦虑和抑郁。有皮肤受累的患者出现焦虑的可能性明显高于无皮肤受累的患者[校正比值比（aOR）=1.8；95%置信区间：1.1，3.0]。有皮肤受累的患者同时存在焦虑和抑郁的可能性也更高（aOR=2.0，95%置信区间：1.2，3.9）。与无皮肤或肌肉骨骼受累的患者相比，有肌肉骨骼（MSK）（aOR=1.9；95%置信区间：1.1，3.5）和皮肤系统（aOR=1.8；95%置信区间：1.04，3.2）受累的患者出现抑郁的可能性更高。就诊时的就业状况和纤维肌痛以及发病状态与焦虑、抑郁和同时存在的焦虑和抑郁分别显著相关。
SLE 临床表型，特别是皮肤或 MSK 系统，以及纤维肌痛、就业和更短的疾病病程与焦虑或抑郁相关。对这些关联进行常规的患者筛查，特别是对病程较短的患者进行筛查，可能有助于诊断这些心理健康障碍，并允许更及时地诊断。
