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

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL

ACS Applied Energy Materials Pub Date : 2024-10-01 DOI:10.1093/rheumatology/keae119

Alessandra Bortoluzzi, Antonis Fanouriakis, Ettore Silvagni, Simone Appenzeller, Linda Carli, Greta Carrara, Alberto Cauli, Fabrizio Conti, Lilian Teresa Lavras Costallat, Ginevra De Marchi, Andrea Doria, Micaela Fredi, Franco Franceschini, Carlo Garaffoni, John G Hanly, Marta Mosca, Elana Murphy, Matteo Piga, Luca Quartuccio, Carlo Alberto Scirè, Paola Tomietto, Simona Truglia, Anna Zanetti, Margherita Zen, George Bertsias, Marcello Govoni

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引用次数: 0

Abstract

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.

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神经精神系统性红斑狼疮的治疗策略和疗效：一项国际多中心回顾性研究。

目的：由于临床试验有限，神经精神系统性红斑狼疮（NPSLE）的治疗面临相当大的挑战。治疗决定是根据可疑的致病机制和症状严重程度定制的。本研究旨在调查首次出现神经精神症状（NP）的NPSLE患者的治疗策略和疾病预后：这项回顾性队列研究根据美国风湿病学会（American College of Rheumatology）的病例定义对NP事件进行了界定，并将其分为三类：中枢性/弥漫性、中枢性/病灶性和周围性。NP事件的归因采用临床判断和经过验证的归因算法。数据包括人口统计学变量、系统性红斑狼疮疾病活动指数、累积性器官损害和非典型肺炎表现的治疗方法。所有 NP 事件的临床结果均由医生通过七点李克特量表来确定。通过多变量逻辑回归分析研究了临床改善/缓解的预测因素：分析包括 350 个事件。因系统性红斑狼疮引起的中枢性弥漫性或局灶性 NP 表现而启动/升级免疫抑制剂和皮质类固醇激素的频率较高。在12个月的随访中，64%的患者NP表现有临床改善。局灶性中枢性事件和系统性红斑狼疮引起的表现与较高的临床改善率相关。根据临床判断，NP表现归因于系统性红斑狼疮并接受免疫抑制剂治疗的患者获得临床应答的概率明显更高（OR 2.55，95%CI 1.06-6.41，p= 0.04）。诊断时的年龄和局灶性中枢事件成为额外的应答预测因素：结论：根据临床判断归因于系统性红斑狼疮并接受免疫抑制剂治疗的NP表现可改善12个月的预后。这强调了准确归因和及时诊断非系统性红斑狼疮的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.