scholarly journals Dissociation in SLE: A part of lupus fog?

Lupus ◽  
2021 ◽  
pp. 096120332110503
Author(s):  
Rory C Monahan ◽  
Anne ME Blonk ◽  
Esther Baptist ◽  
Huub AM Middelkoop ◽  
Margreet Kloppenburg ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Adult Population ◽  
Dissociative Disorder ◽  
Total Study Population ◽  
Tertiary Referral Center ◽  
Dissociative Symptoms ◽  
General Adult Population ◽  
Dissociative Experience Scale ◽  
Neuropsychiatric Manifestations

Introduction Lupus fog is ill-defined. We aimed to study whether lupus fog is the result of dissociation by studying the prevalence of dissociation and dissociative fog in patients with SLE and neuropsychiatric manifestations of inflammatory and non-inflammatory origin. Methods Patients visiting the tertiary referral center for neuropsychiatric systemic lupus erythematosus (NPSLE) of the LUMC between 2007–2019 were included. Patients were classified as having neuropsychiatric symptoms of inflammatory or non-inflammatory origin. Dissociation was studied using the Dissociative Experience Scale-II (DES), in which the presence of 28 dissociative symptoms is rated (0–100% of the time), of which one question assesses the presence of a dissociative fog directly. Average scores are calculated and scores ≥ 25 are considered indicative of a dissociative disorder. A score of ≥ 30 on question 28 (dissociative fog) was considered indicative for the presence of a fog. Summary scores in the general adult population range from 4.4 to 14. Multiple regression analysis (MRA) was performed to study the association between inflammatory neuropsychiatric symptoms and dissociation. DES results are presented as median (range) and MRA as B and 95% confidence interval (CI). Results DES questionnaires were available for 337 patients, of which 69 had an inflammatory NPSLE phenotype (20%). Mean age in the total study population was 43 ± 14 years and the majority was female (87%). The median dissociation score was 7.1 (0–75) and did not differ between patients with neuropsychiatric symptoms of inflammatory or non-inflammatory origin (B: −0.04 (95% CI: −0.17; 0.09)). 35 patients (10%) had a score indicative of a dissociative disorder. The most common type of dissociation was absorption/imagination. 43 patients (13%) reported a dissociative fog. Discussion In most patients with SLE and neuropsychiatric symptoms, dissociative symptoms are within normal range, regardless of underlying etiology. Dissociative fog is present, but uncommon. Lupus fog is most likely not associated with dissociation.

scholarly journals POS0709 LUPUS FOG IS NOT DISSOCIATIVE FOG

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 604.1-604
Author(s):  
R. Monahan ◽  
A. Blonk ◽  
H. Middelkoop ◽  
M. Kloppenburg ◽  
T. Huizinga ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Adult Population ◽  
Systemic Lupus ◽  
Tertiary Referral Center ◽  
Neuropsychiatric Systemic Lupus Erythematosus ◽  
Dissociative Symptoms ◽  
Dissociative Experience ◽  
Dissociative Experience Scale

Background:The presence of a ‘fog’ is frequently reported by patients with systemic lupus erythematosus (SLE). However, little is known about this lupus fog: it is thought to be a result of cognitive dysfunction, but fogs can also be the result of dissociation. The Dissociative Experience Scale-II (DES) is a standardized tool to study dissociation. In the general adult population, scores range from 4.4-14.1-3Objectives:We aimed to study the prevalence of dissociative symptoms including dissociative fog in patients with SLE and neuropsychiatric symptoms.Methods:Patients visiting the tertiary referral center for neuropsychiatric systemic lupus erythematosus (NPSLE) of the LUMC between 2007-2019 were included. All patients underwent a standardized multidisciplinary assessment. Patients were classified as NPSLE if neuropsychiatric symptoms were attributed to SLE and immunosuppressive or anticoagulant therapy was initiated, otherwise patients were classified as minor/non-NPSLE. Dissociation was studied using the DES. The DES separates different types of dissociative symptoms: amnesia, absorption/imagination and derealization/depersonalization. It also contains one question regarding evaluating the presence of a dissociative fog: “Some people sometimes feel as if they are looking at the world through a fog, so that people and objects appear far away or unclear”. All statements (n = 28) regarding dissociative symptoms are rated from ‘none of the time’ to ‘all of the time’ (0-100%); scores >25 are considered abnormal. A multiple regression analysis (MRA) were performed to compare dissociation in patients with and without NPSLE. DES results are presented as median (range) and MRA as odds ratio (OR) and 95% confidence interval (CI).Results:DES questionnaires were available for 337 patients, of which 97 had the diagnosis NPSLE (29%). Mean age in patients with NPSLE was 41 ± 13 years and 84% was female. In minor/non-NPSLE, median age was 44 ± 14 years and 87% was female.Median dissociation was 7 (0-75) and did not differ between patients with minor/non-NPSLE and NPSLE (OR: 1.0 (95% CI: -0.9; 1.1)). The most common type of dissociation was absorption/imagination (median: 12, range 0-75) and depersonalization/derealization was infrequent (median: 1, range 0-84). 43 patients (13%) had an abnormal score (>25) on the dissociative fog question.Conclusion:Dissociative symptoms are within normal range in patients with SLE and neuropsychiatric symptoms, regardless of underlying etiology. Dissociative fog seems uncommon and therefore lupus fog is most likely not the result of dissociation.References:[1]Bernstein EM and Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986; 174: 727-735. 1986/12/01. DOI: 10.1097/00005053-198612000-00004.[2]Maaranen P, Tanskanen A, Honkalampi K, et al. Factors associated with pathological dissociation in the general population. Aust N Z J Psychiatry 2005; 39: 387-394. 2005/04/30. DOI: 10.1080/j.1440-1614.2005.01586.x.[3]van IJzendoorn MH and Schuengel C. The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical Psychology Review 1996; 16: 365-382. DOI: 10.1016/0272-7358(96)00006-2.Table 1.Presence of dissociation in patients with SLE and neuropsychiatric symptomsTotal cohort(n = 337)Minor/non-NPSLE(n = 240)NPSLE(n = 97)DES (median, range)Total questionnaire7 (0 - 75)8 (0 - 66)6 (0 – 75)Amnesia5 (0 - 76)5 (0 - 68)4 (0 - 76)Absorption/imagination12 (0 – 75)13 (0 – 75)10 (0 – 73)Depersonalization/derealization1 (0 – 84)1 (0 – 73)1 (0 – 84)Dissociative fog* 0 (0-100)0 (0-100)0 (0-100)DES = Dissociative Experience Scale NPSLE = neuropsychiatric systemic lupus erythematosus.*Dissociative fog is question 28 of the DES-IIDisclosure of Interests:None declared

scholarly journals Mania in an individual with Systemic Lupus Erythematosus – A case report

2021 ◽  
pp. 36-40
Author(s):  
Soumya RS ◽  
◽  
Sharon Joe Daniel ◽  
Malaiappan Meenakshisundaram
Keyword(s):  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Case Definition ◽  
Diagnostic Process ◽  
Systemic Lupus ◽  
Case Definitions ◽  
American College Of Rheumatology ◽  
Psychiatric Disturbances ◽  
Neuropsychiatric Sle ◽  
Neuropsychiatric Manifestations

Neuropsychiatric manifestations are common and occur in around 14-80% of patients with SLE. No particular neurologic or psychiatric manifestation is characteristic of SLE and the form and pattern of neuropsychiatric symptoms vary significantly. The American College of Rheumatology (ACR) Nomenclature provides case definition for 19 neuropsychiatric syndromes seen in SLE. However, these case definitions were not found to be effective in differentiating neuropsychiatric SLE (NPSLE) patients from those with neuropsychiatric manifestations not associated with SLE.Here we present a case of mania in a patient with SLE and discuss the differential diagnosis of neuropsychiatric manifestations of SLE and primary mood disorder. Symptoms of neuropsychiatric SLE vary significantly and psychiatric disturbances in a patient with SLE is a diagnosis of exclusion where other possibilities have to be considered including an independent comorbid psychiatric disorder. This case highlights the difficulty in the diagnostic process and the need for more studies on the differences between primary psychiatric disorders and neuropsychiatric SLE.

scholarly journals Neuropsychiatric Involvement in Juvenile-Onset Systemic Lupus Erythematosus

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Mohammad-Amin Khajezadeh ◽  
Gholamreza Zamani ◽  
Bobak Moazzami ◽  
Zahra Nagahi ◽  
Mahdie Mousavi-Torshizi ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Nervous System ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Deep Tendon Reflex ◽  
Systemic Lupus ◽  
Case Definitions ◽  
Juvenile Onset ◽  
Neuropsychiatric Manifestations ◽  
Onset Systemic Lupus Erythematosus

Objective. Systemic lupus erythematosus (SLE) is a complex autoimmune disorder characterized by multisystem involvement, including the nervous system. In the present study, we aimed to assess neuropsychiatric manifestations in juvenile-onset systemic lupus erythematosus (JSLE) in Iran. Methods. One hundred and forty-six pediatric onset patients with SLE who had registered in our pediatric rheumatology database were evaluated prospectively and cross sectionally within 2013-2015. Data including sex, age, age at the time of diagnosis, age at the time of study, physical examination, laboratory review, and neuropsychiatric inventory were extracted from this database. Classification of neuropsychiatric JSLE was according to the 1999 American College of Rheumatology (ACR) neuropsychiatric manifestations of SLE case definitions. Result. A total number of 41 patients with neuropsychiatric symptoms were selected. The patients’ average age was 12.2 years. The most common neuropsychiatric symptoms were seizures, migraine, and depression. The mean age at the onset of symptoms was 10.2 ± 3 years. Mean follow-up period was 57±34 (range: 12-120) months. From 41 SLE patients, 18 (43.9) presented symptoms at the time of diagnosis. In thirteen (31.7%) patients, neurological symptoms were developed more than 1 year after SLE diagnosis. Headache was the most common feature (13%), followed by seizure (9.5%) and chorea (3.4%). Other neurological manifestations included cranial nerve involvement (0.7%), loss of consciousness (2.7%), and impaired deep tendon reflex neuropathy (2.5%). The least common neuropsychiatric JSLE manifestation was aseptic meningitis seen in only one patient (0.7%). Conclusion. The presence of headache, mood disorders, psychosis, depression, and other neuropsychological manifestations in a patient with JSLE should prompt investigations into diagnosis of the primary nervous system involvement in order to reduce mortality and morbidity.

scholarly journals POS0738 BLUNTED CEREBRAL OXYGENATION DURING EXERCISE IN NON-NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 620-620
Author(s):  
N. Koletsos ◽  
K. Dipla ◽  
A. Triantafyllou ◽  
A. Lazaridis ◽  
N. Papadopoulos ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Blood Pressure ◽  
Lupus Erythematosus ◽  
Cerebral Oxygenation ◽  
Neuropsychiatric Symptoms ◽  
Handgrip Exercise ◽  
Systemic Lupus ◽  
Brain Oxygenation ◽  
Neuropsychiatric Systemic Lupus Erythematosus ◽  
Neuropsychiatric Manifestations

Background:Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organs, including the central nervous system. Subclinical brain lesions have been reported in SLE patients, even without overt neuropsychiatric manifestations (non-NPSLE). Studies using PET/MRI, examining structural or functional brain abnormalities in SLE, have been previously performed, either at rest or during a mental task (1–3). Exercise can be used to identify early alterations in brain oxygenation that might not detectable during resting conditions (4).Objectives:Our study aimed to examine possible differences in cerebral oxygenation during a handgrip exercise test between SLE patients without neuropsychiatric manifestations and age-matched controls.Methods:Fifty-two participants (26 non-NPSLE and 26 controls), following evaluation of handgrip strength, underwent a protocol involving a seated rest (baseline), a 3-min handgrip exercise (at 30% of maximal strength), and a 3-min recovery. Continuous-near-infrared-spectroscopy (NIRS) was used to monitor changes in cerebral-oxygenated hemoglobin (O2Hb), de-oxygenated (HHb) and total-hemoglobin (tHb). Beat-by-beat blood pressure (Finapres) was continuously monitored.Results:There were no differences between the two groups in age, body mass index, blood pressure, and smoking status. Median SLE duration was 7.5 (3.0 – 16.0) years. During exercise, cerebral -O2Hb increased in both groups; however, non-NPSLE exhibited a significantly lower increase in O2Hb vs. controls (average response:1.20±0.89 vs. 2.33±1.61μM, respectively, p<0.005) and lower tHb responses (p<0.05), with no differences in HHb.Conclusion:Our data show, for the first time, that SLE patients even without overt neuropsychiatric manifestations exhibit a blunted increase in cerebral-O2Hb during a submaximal exercise stimulus compared to age-matched controls. Examining brain oxygenation during a simple exercise task may assist in identifying patients with early alterations in cerebral function.References:[1]Mak A, Ren T, Fu EH yun, Cheak AA cia, Ho RCM. A Prospective Functional MRI Study for Executive Function in Patients with Systemic Lupus Erythematosus Without Neuropsychiatric Symptoms. Semin Arthritis Rheum. 2012;41(6):849–58.[2]Kozora E, Brown MS, Filley CM, Zhang L, Miller DE, West SG, et al. Memory impairment associated with neurometabolic abnormalities of the hippocampus in patients with non-neuropsychiatric systemic lupus erythematosus. Lupus. 2011;20(6):598–606.[3]Mackay M, Vo A, Tang CC, Small M, Anderson EW, Ploran EJ, et al. Metabolic and microstructural alterations in the SLE brain correlate with cognitive impairment. JCI Insight. 2019;4(1).[4]Triantafyllou GA, Dipla K, Triantafyllou A, Gkaliagkousi E, Douma S. Measurement and Changes in Cerebral Oxygenation and Blood Flow at Rest and During Exercise in Normotensive and Hypertensive Individuals. Vol. 22, Current Hypertension Reports. Springer; 2020.Disclosure of Interests:None declared

scholarly journals Neuropsichyatric Manifestations of Systemic Lupus Erythematosus: Diagnosis and Treatment Approach

2017 ◽  
Vol 0 (0) ◽  
Author(s):  
Alesandra Tomic Lucic
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Nervous System ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Neuropsychiatric Symptoms ◽  
Pathological Process ◽  
Main Role ◽  
Systemic Lupus ◽  
Systemic Lupus Erythematosus Diagnosis ◽  
Neuropsychiatric Manifestations

Abstract Neuropsychiatric involvement in systemic lupus erythematosus includes heterogeneous manifestations involving both the central and peripheral nervous system. A major issue in clinical evaluation is the attribution of neuropsychiatric symptoms to systemic lupus erithematosus. Antiphospholipid antibodies, immune complex, microangiopathy, early and accelerated arteriosclerosis are factors that have the main role in pathogenesis of neuropsychiatric manifestations of systemic lupus erithematosus. Th ere are no neurological symptoms specific to systemic lupus erithematosus, but they can also occur very commonly in the general population. Lesions of nervous system can be focal or diff use and may be due to systemic lupus erithematosus itself (primary lesions), but it also may be caused by other diseases or disbalances. Therapy of the neuropsychiatric manifestations depends on the nature of the pathological process (dominant inflammation or thrombosis). If it is result of an inflammatory neurotoxic process and in the presence of an increased activity of systemic lupus erithematosus, therapy includes glycocorticoids independently or in combination with immunosuppressives. Focal neuropsychiatric syndrome with antiphospholipid antibodies positivity should be treated with anticoagulant and/ or antiplatelet therapy. In addition, control of classical cardiovascular risk factors, stop smoking, and treatment with hydroxychloroquine is recommended.

scholarly journals A critical analysis of the tools to evaluate neuropsychiatric lupus

Lupus ◽  
2017 ◽  
Vol 26 (5) ◽  
pp. 504-509 ◽  
Author(s):  
K E N Clark ◽  
C N Clark ◽  
A Rahman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systemic Lupus Erythematosus ◽  
Magnetic Resonance ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Testing ◽  
Resonance Imaging ◽  
Systemic Lupus ◽  
Neuropsychiatric Systemic Lupus Erythematosus ◽  
Neuropsychiatric Manifestations

Neuropsychiatric symptoms occur commonly in patients with systemic lupus erythematosus, but they are not always due to active disease. It is crucial to identify cases that are due to active systemic lupus erythematosus so that appropriate treatment can be instituted. There is no single serological or imaging test that distinguishes active neuropsychiatric systemic lupus erythematosus from neuropsychiatric manifestations caused by other factors such as infection. Most patients with neuropsychiatric systemic lupus erythematosus have generalised features of disease activity. Raised anti-dsDNA and low C3 complement levels are often seen, but are not an invariable guide. The presence of antiphospholipid antibodies is more suggestive of thrombotic than inflammatory causation. A number of other autoantibody tests have been proposed as biomarkers for neuropsychiatric systemic lupus erythematosus, but results in clinical studies have been inconsistent and none has so far entered routine clinical practice. Cerebrospinal fluid features and magnetic resonance imaging appearances are non-specific in neuropsychiatric systemic lupus erythematosus, but are useful in excluding other causes of neuropsychiatric symptoms. Newer magnetic resonance imaging sequences show promise for distinguishing new neuropsychiatric systemic lupus erythematosus activity from previous damage and recent research suggests these may correlate with changes in cognitive function in patients with systemic lupus erythematosus. However, formal cognitive testing is seldom carried out in the acute setting.

scholarly journals Systemic Lupus Erythematosus with neuropsychiatric manifestations in a child: case report and review of the international recommendations for the diagnostics and management

2021 ◽  
Vol 66 (1) ◽  
pp. 98-105
Author(s):  
E. M. Кuchinskaya ◽  
Yu. A. Yakovleva ◽  
M. A. Rakova ◽  
N. A. Lyubimova ◽  
E. N. Suspitsin ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Central Nervous System ◽  
Lupus Erythematosus ◽  
Clinical Case ◽  
Neuropsychiatric Symptoms ◽  
Correct Diagnosis ◽  
Interdisciplinary Approach ◽  
Teenage Girl ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestations

The article describes a clinical case of a teenage girl with systemic lupus erythematosus with neuropsychiatric manifestations. The overview part describes modern approaches to the diagnosis and treatment of children with systemic lupus erythematosus with central nervous system lesions. The authors describe actual Russian and international clinical recommendations, they pay particular attention to the imperfection and inconsistency of classifications, differences in terminological systems, and the features of the rheumatologists’ and psychiatrists’ clinical practice. They provide the recommendations on the correct diagnosis wording in children with neuropsychiatric symptoms as a part of autoimmune disease. The article substantiates the necessity of an interdisciplinary approach and the cooperation of pediatric rheumatologists, psychiatrists, neurologists, clinical psychologists.

Awareness of general adult population of Saudi Arabia toward Bell’s palsy

2020 ◽  
pp. 1191-1197
Author(s):  
Sultan Alamrani ◽  
Shahd Rummani ◽  
Zainab Khamdan ◽  
Aisha Alharbi ◽  
Ahmad Alshahrani ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Adult Population ◽  
General Adult Population

Unravelling the phenotypic tangle of autistic, schizotypal and social anxiety traits: A Network Analysis

2020 ◽  
Author(s):  
Orestis Zavlis ◽  
Myles Jones
Keyword(s):  
Network Analysis ◽  
Social Anxiety ◽  
Factor Structure ◽  
Adult Population ◽  
Autism Spectrum ◽  
Underlying Structure ◽  
Schizotypal Personality ◽  
The Social ◽  
Trait Level ◽  
General Adult Population

Substantial overlap exists between schizophrenia and autism spectrum disorders, with part of that overlap hypothesised to be due to comorbid social anxiety. The current paper investigates the interactions and factor structure of these disorders at a personality trait level, through the lens of a network model. The items of the Autism Quotient (AQ), Schizotypal Personality Questionnaire Brief-Revised (SPQ-BR), and the Liebowitz Social Anxiety Scale (L-SAS) were combined and completed by 345 members of the general adult population. An Exploratory Graph Analysis (EGA) on the AQ-SPQ-BR combined inventory revealed two communities (factors), which reflected the general autism and schizotypal phenotypes. An additional EGA on all inventories validated the AQ-SPQ-BR factor structure and revealed another community, Social Anxiety (L-SAS). A Network Analysis (NA) on all inventories revealed several moderately central subscales, which collectively reflected the social-interpersonal impairments of the three disorders. The current results suggest that a combination of recent network- and traditional factor-analytic techniques may present a fruitful approach to understanding the underlying structure as well as relation of different psychopathologies.

scholarly journals Fatigue in patients with systemic lupus erythematosus and neuropsychiatric symptoms is associated with anxiety and depression rather than inflammatory disease activity

Lupus ◽  
2021 ◽  
pp. 096120332110050
Author(s):  
Rory C Monahan ◽  
Liesbeth JJ Beaart-van de Voorde ◽  
Jeroen Eikenboom ◽  
Rolf Fronczek ◽  
Margreet Kloppenburg ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Anxiety And Depression ◽  
Systemic Lupus ◽  
Sf 36 ◽  
Neuropsychiatric Sle ◽  
Inflammatory Phenotype ◽  
The Mean

Introduction We aimed to investigate risk factors for fatigue in patients with systemic lupus erythematosus (SLE) and neuropsychiatric symptoms in order to identify potential interventional strategies. Methods Patients visiting the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center between 2007–2019 were included. In a multidisciplinary consensus meeting, SLE patients were classified as having neuropsychiatric symptoms of inflammatory origin (inflammatory phenotype) or other origin (non-inflammatory phenotype). Fatigue was assessed with the SF-36 vitality domain (VT) since 2007 and the multidimensional fatigue inventory (MFI) and visual analogue scale (VAS) since 2011. Patients with a score on the SF-36 VT ≥1 standard deviation (SD) away from the mean of age-related controls of the general population were classified as fatigued; patients ≥2 SD away were classified as extremely fatigued. Disease activity was measured using the SLE disease activity index-2000. The influence of the presence of an inflammatory phenotype, disease activity and symptoms of depression and anxiety as measured by the hospital anxiety and depression scale (HADS) was analyzed using multiple regression analyses corrected for age, sex and education. Results 348 out of 371 eligible patients filled in questionnaires and were included in this study . The majority was female (87%) and the mean age was 43 ± 14 years. 72 patients (21%) had neuropsychiatric symptoms of an inflammatory origin. Fatigue was present in 78% of all patients and extreme fatigue was present in 50% of patients with an inflammatory phenotype vs 46% in the non-inflammatory phenotype. Fatigue was similar in patients with an inflammatory phenotype compared to patients with a non-inflammatory phenotype on the SF-36 VT (β: 0.8 (95% CI −4.8; 6.1) and there was less fatigue in patients with an inflammatory phenotype on the MFI and VAS (β: −3.7 (95% CI: −6.9; −0.5) and β: −1.0 (95% CI −1.6; −0.3)). There was no association between disease activity and fatigue, but symptoms of anxiety and depression (HADS) associated strongly with all fatigue measurements. Conclusion This study suggests that intervention strategies to target fatigue in (NP)SLE patients may need to focus on symptoms of anxiety and depression rather than immunosuppressive treatment.

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