Neuropsychiatric symptoms in Systemic Lupus Erythematosus: mixed methods analysis of patient-derived attributional evidence in the international INSPIRE project.

التفاصيل البيبلوغرافية
العنوان:	Neuropsychiatric symptoms in Systemic Lupus Erythematosus: mixed methods analysis of patient-derived attributional evidence in the international INSPIRE project.
المؤلفون:	Sloan M; Department of Public Health and Primary Care Unit, University of Cambridge, UK., Pollak TA; Institute of Psychiatry, Psychology and Neuroscience, King's College London, and South London and Maudsley NHS foundation trust, London, UK., Massou E; Department of Public Health and Primary Care Unit, University of Cambridge, UK., Leschziner G; Department of Neurology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Andreoli L; Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, ; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Harwood R; Swansea University Medical School, Wales., Bosley M; Patient and Public Co-Investigators., Pitkanen M; Institute of Psychiatry, Psychology and Neuroscience, King's College London, and South London and Maudsley NHS foundation trust, London, UK., Diment W; Patient and Public Co-Investigators., Bortoluzzi A; Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy., Zandi MS; Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK., Ubhi M; Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK., Gordon C; Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK., Jayne D; Department of Medicine, University of Cambridge, UK., Naughton F; Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK., Barrere C; Patient and Public Co-Investigators., Wincup C; Department of Rheumatology, Kings College Hospital London, UK., Brimicombe J; Department of Public Health and Primary Care Unit, University of Cambridge, UK., Bourgeois JA; Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, California, United States., D'Cruz D; The Louise Coote Lupus Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
المصدر:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Mar 22. Date of Electronic Publication: 2024 Mar 22.
Publication Model:	Ahead of Print
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Oxford University Press Country of Publication: England NLM ID: 100883501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1462-0332 (Electronic) Linking ISSN: 14620324 NLM ISO Abbreviation: Rheumatology (Oxford) Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Oxford, UK : Avenel, N.J. : Oxford University Press ; Distributed by Mercury International, c1999-
مستخلص:	Objective: Attribution of neuropsychiatric symptoms in systemic lupus erythematosus (SLE) relies heavily on clinician assessment. Limited clinic time, variable knowledge, and symptom under-reporting contributes to discordance between clinician assessments and patient symptoms. We obtained attributional data directly from patients and clinicians in order to estimate and compare potential levels of direct attribution to SLE of multiple neuropsychiatric symptoms using different patient-derived measures. Methods: Quantitative and qualitative data analysed included: prevalence and frequency of neuropsychiatric symptoms, response to corticosteroids, and concurrence of neuropsychiatric symptoms with non-neuropsychiatric SLE disease activity. SLE patients were also compared with controls and inflammatory arthritis (IA) patients to explore attributability of neuropsychiatric symptoms to the direct disease effects on the brain/nervous system. Results: We recruited 2,817 participants, including 400 clinicians. SLE patients (n = 609) reported significantly higher prevalences of neuropsychiatric symptoms than controls (n = 463) and IA patients (n = 489). SLE and IA patients' quantitative data demonstrated multiple neuropsychiatric symptoms relapsing/remitting with other disease symptoms such as joint pain. Over 45% of SLE patients reported resolution/improvement of fatigue, positive sensory symptoms, severe headache, and cognitive dysfunction with corticosteroids. Evidence of direct attributability in SLE was highest for hallucinations and severe headache. SLE patients had greater reported improvement from corticosteroids (p= 0.008), and greater relapsing-remitting with disease activity (p< 0.001) in the comparisons with IA patients for severe headache. Clinician and patients reported insufficient time to discuss patient-reported attributional evidence. Symptoms viewed as indirectly related/non-attributable were often less prioritised for discussion and treatment. Conclusion: We found evidence indicating varying levels of direct attributability of both common and previously unexplored neuropsychiatric symptoms in SLE patients, with hallucinations and severe headache assessed as the most directly attributable. There may also be-currently under-estimated-direct effects on the nervous system in IA and other systemic rheumatological diseases. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
فهرسة مساهمة:	Keywords: CNS lupus; NPSLE; Neuropsychiatric lupus; SLE; attribution; autoimmunity; biopsychosocial; diagnosis; inflammatory arthritis; mental health; misattribution; patient-clinician interactions; rheumatology
تواريخ الأحداث:	Date Created: 20240322 Latest Revision: 20240322
رمز التحديث:	20240323
DOI:	10.1093/rheumatology/keae194
PMID:	38518094
قاعدة البيانات:	MEDLINE

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تدمد:	1462-0332
DOI:	10.1093/rheumatology/keae194