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Medicine (Baltimore). 2006 Jul;85(4):221-8.
Neuropsychiatric damage in Southern Chinese patients with systemic lupus
erythematosus.
Mok CC, To CH, Mak A.
Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China. ccmok2005@yahoo.com
Abstract
We conducted the current study to determine the prevalence and predictors of neuropsychiatric
damage in a cohort of Chinese patients with systemic lupus erythematosus (SLE). Patients were
those newly diagnosed as having SLE between 1990 and 2004 in our unit. Demographic data,
presenting and cumulative clinical features, disease activity score at diagnosis, and serial damage
scores were obtained. Neuropsychiatric (NP) manifestations were classified according to the
American College of Rheumatology (ACR) nomenclature. NP damage was evaluated by the NP
domain of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology
(SLICC/ACR) Damage Index. Factors predictive of NP damage were studied by regression models.
We studied 282 patients who fulfilled > or =4 of the ACR criteria for SLE. The mean age of SLE onset
was 31.8 +/- 14 years. After a mean follow-up of 6.7 years, 65 patients (23%) had at least 1 NP
manifestation and 50 (18%) developed NP damage (SLICC/ACR Damage Index > or = 1).
Cerebrovascular accident was the most common cause of NP damage (35%), followed by seizure
(20%), psychosis (12%), cranial/peripheral neuropathy (12%), cognitive dysfunction (12%), and
myelopathy (9%). In a multiple regression model, disease activity at diagnosis, cumulative non-NP
damage, presence of antiphospholipid antibodies, and ever use of pulse methylprednisolone were
independent factors associated with NP damage. New NP damage after the first year of diagnosis
was predicted by longer disease duration and the use of pulse methylprednisolone in another
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multivariate model. Neither early nor cumulative NP damage predicted mortality. NP damage is
prevalent in Chinese patients with SLE and is independently associated with more active disease at
diagnosis, antiphospholipid antibodies and the use of pulse methylprednisolone therapy. Primary
prevention for cerebrovascular disease in high-risk patients may reduce NP damage.
PMID: 16862047 [PubMed - indexed f or MEDLINE]
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