Therapeutic strategies and outcomes in neuropsychiatric systemic lupus erythematosus: an international multicentre retrospective study.

Autor:	Bortoluzzi A; Section of Rheumatology, Department of Medical Sciences University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, Italy., Fanouriakis A; Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece., Silvagni E; Section of Rheumatology, Department of Medical Sciences University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, Italy., Appenzeller S; Rheumatology Unit, Department of Orthopedics, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil., Carli L; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Carrara G; Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy., Cauli A; Rheumatology Unit, University Clinic, AOU Cagliari, Cagliari, Italy.; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy., Conti F; Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari (SCIAC), Sapienza University, Rome, Italy., Costallat LTL; Rheumatology Unit, Department of Orthopedics, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil., De Marchi G; Rheumatology Unit, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy., Doria A; Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy., Fredi M; Rheumatology and Clinical Immunology Unit and Clinical and Experimental Science Department ASST Spedali Civili and University of Brescia, Brescia, Italy., Franceschini F; Rheumatology and Clinical Immunology Unit and Clinical and Experimental Science Department ASST Spedali Civili and University of Brescia, Brescia, Italy., Garaffoni C; Section of Rheumatology, Department of Medical Sciences University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, Italy., Hanly JG; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada., Mosca M; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Murphy E; Division of Rheumatology, Departments of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada., Piga M; Rheumatology Unit, University Clinic, AOU Cagliari, Cagliari, Italy.; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy., Quartuccio L; Rheumatology Unit, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy., Scirè CA; Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy.; School of Medicine, University of Milano Bicocca, Milan, Italy., Tomietto P; Internal Medicine Department, Rheumatology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy., Truglia S; Rheumatology Unit, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy., Zanetti A; Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy., Zen M; Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy., Bertsias G; Department of Rheumatology, Clinical Immunology, University of Crete Medical School and University Hospital of Heraklion, Heraklion, Greece.; Laboratory of Rheumatology, Autoimmunity and Inflammation, Infections & Immunity Division, Institute of Molecular Biology and Biotechnology (FORTH), Heraklion, Greece., Govoni M; Section of Rheumatology, Department of Medical Sciences University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, Italy.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Oct 01; Vol. 63 (10), pp. 2711-2720.
DOI:	10.1093/rheumatology/keae119
Abstrakt:	Objectives: The management of neuropsychiatric systemic lupus erythematosus (NPSLE) poses considerable challenges due to limited clinical trials. Therapeutic decisions are customized based on suspected pathogenic mechanisms and symptoms severity. This study aimed to investigate therapeutic strategies and disease outcome for patients with NPSLE experiencing their first neuropsychiatric (NP) manifestation. Methods: This retrospective cohort study defined NP events according to the American College of Rheumatology case definition, categorizing them into three clusters: central/diffuse, central/focal and peripheral. Clinical judgment and a validated attribution algorithm were used for NP event attribution. Data included demographic variables, SLE disease activity index, cumulative organ damage, and NP manifestation treatments. The clinical outcome of all NP events was determined by a physician seven-point Likert scale. Predictors of clinical improvement/resolution were investigated in a multivariable logistic regression analysis. Results: The analysis included 350 events. Immunosuppressants and corticosteroids were more frequently initiated/escalated for SLE-attributed central diffuse or focal NP manifestations. At 12 months of follow-up, 64% of patients showed a clinical improvement in NP manifestations. Focal central events and SLE-attributed manifestations correlated with higher rates of clinical improvement. Patients with NP manifestations attributed to SLE according to clinical judgment and treated with immunosuppressants had a significantly higher probability of achieving clinical response (OR 2.55, 95%CI 1.06-6.41, P = 0.04). Age at diagnosis and focal central events emerged as additional response predictors. Conclusion: NP manifestations attributed to SLE by clinical judgment and treated with immunosuppressants demonstrated improved 12-month outcomes. This underscores the importance of accurate attribution and timely diagnosis of NPSLE. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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