Mental health problems frequently overlooked in lupus

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Mental health problems frequently overlooked in lupus

Aug 4, 2005 Gandey

Halifax, NS - A new study has found that patients with systemic lupus

erythematosus (SLE) and neuropsychiatric syndromes report more symptoms

of depression and cognitive dysfunction compared to patients with

rheumatoid arthritis (RA) and similar mental-health problems [1]. Yet

lupus patients do not report significantly poorer health-related

quality of life. In a paper appearing in the August 2005 issue of the

Journal of Rheumatology, researchers say this points to

non-disease-specific causes of neuropsychiatric disorders that

clinicians are going to need to watch for.

" The overall prevalence of neuropsychiatric syndromes in our sample of

systemic lupus erythematosus patients was 28%, and the most frequent

were headache, mood disorder, and anxiety disorders, " the team reports.

" In RA patients, who were well matched for demographic, clinical, and

treatment variables, the overall prevalence of neuropsychiatric

syndromes was even higher at 47%, and the most common events were

similar to those seen in lupus. "

Dr Hanly (Source: Dalhousie University)

Led by Dr Hanly (Dalhousie University, Halifax, NS), the

researchers explain that the non-disease-specific expression of

neuropsychiatric syndromes in lupus has implications for the management

of individual patients as well as for the design of future studies to

examine pathogenesis and treatment.

Supported by a grant from the Canadian Institutes of Health Research,

Hanly and colleagues looked at 53 lupus patients matched with 53

patients with RA. All participants were attending ambulatory clinics in

a single academic medical center and fulfilled the American College of

Rheumatology (ACR) classification criteria for either SLE or RA. Using

the ACR nomenclature and case definitions for 19 neuropsychiatric

syndromes, the researchers determined the cumulative number of

manifestations. They measured depression and anxiety with hospital

anxiety and depression scales and assessed symptoms of cognitive

dysfunction with the cognitive symptoms inventory. The group evaluated

health-related quality of life with the Short Form-36 and studied

fatigue using the 10-point Likert scale.

More than half of the neuropsychiatric events occurred before lupus

diagnosis

The investigators observed no significant differences in self-reported

health-related quality of life, fatigue, anxiety, depression, and

cognitive symptoms between the two groups. They found that the

proportion of patients with cumulative neuropsychiatric events was

higher in RA than in lupus and the occurrence of multiple events in

individual patients was comparable in both groups (53% in lupus and 48%

in RA, p= 0.75). More than half of the neuropsychiatric events occurred

before the diagnosis of lupus or RA.

Hanly and colleagues report that many events were common to lupus and

RA. They write, " RA has a number of similarities to lupus with regard

to clinical features and treatment, but with certain exceptions such as

upper cervical cord compression and peripheral neuropathies, RA does

not cause nervous system disease. " They continue that the finding that

anxiety, headache, and mood disorders were of comparable frequency in

lupus and RA patients was therefore of " considerable interest. " The

researchers explain that although this observation does not exclude the

possibility that different pathogenic mechanisms may be responsible for

these manifestations in lupus and RA, it does suggest that lupus

patients are not more likely to experience these symptoms than patients

with other chronic rheumatic diseases.

The group concludes that while neuropsychiatric manifestations in lupus

and RA patients were not associated with poorer health-related quality

of life on a generic profile measure, they were associated with greater

psychological distress in patients with lupus. " This emphasizes the

importance of recognizing the mental-health issues of these patients

and of symptomatic therapy. " They point out that the diagnosis of

neuropsychiatric problems in lupus is complicated because its

occurrence in individual patients may be the result of a primary

immunopathogenic mechanism or an alternative disease.

Source

1. Hanly JG, Fisk JD, McCurdy G, et al. Neuropsychiatric syndromes

in patients with systemic lupus erythematosus and rheumatoid arthritis.

J Rheumatol 2005; 32:1459-1460.