Attribution of psychiatric manifestations to systemic lupus erythematosus in Chinese patients: A retrospective study.

Abstract

Background: Not all neuropsychiatric (NP) manifestations in patients with systemic lupus erythematosus (SLE) are secondary to lupus. The clarification of the cause of NP symptoms influences therapeutic strategies for SLE.

Aim: To understand the attribution of psychiatric manifestations in a cohort of Chinese patients with SLE.

Methods: This retrospective single-center study analyzed 160 inpatient medical records. Clinical diagnosis, which is considered the gold standard, was used to divide the subjects into a psychiatric SLE (PSLE) group (G1) and a secondary psychiatric symptoms group (G2). Clinical features were compared between these two groups. The sensitivity and specificity of the Italian attribution model were explored.

Results: A total of 171 psychiatric syndromes were recorded in 138 patients, including 87 cases of acute confusional state, 40 cases of cognitive dysfunction, 18 cases of psychosis, and 13 cases each of depressive disorder and mania or hypomania. A total of 141 (82.5%) syndromes were attributed to SLE. In contrast to G2 patients, G1 patients had higher SLE Disease Activity Index-2000 scores (21 vs 12, P = 0.001), a lower prevalence of anti-beta-2-glycoprotein 1 antibodies (8.6% vs 25.9%, P = 0.036), and a higher prevalence of anti-ribosomal ribonucleoprotein particle (rRNP) antibodies (39.0% vs 22.2%, P = 0.045). The Italian attribution model exhibited a sensitivity of 95.0% and a specificity of 70.0% when the threshold value was set at 7.

Conclusion: Patients with PSLE exhibited increased disease activity. There is a correlation between PSLE and anti-rRNP antibodies. The Italian model effectively assesses multiple psychiatric manifestations in Chinese SLE patients who present with NP symptoms.