scholarly journals Association between Cognitive Impairment and Olfactory Deficits in Systemic Lupus Erythematosus Without Major Neuropsychiatric Syndromes

2021 ◽  
Author(s):  
Xue Xu ◽  
Wei Kong ◽  
Linyu Geng ◽  
Chen Chen ◽  
Hailong Yang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cognitive Impairment ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Olfactory Function ◽  
Systemic Lupus ◽  
Immediate Memory ◽  
Accumulated Damage ◽  
Neuropsychological Status ◽  
Repeatable Battery

Abstract Objective Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed despite its high morbidity and mortality. The aim of the study was to investigate the utility of a brief neuropsychological battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), to evaluate cognitive deficits in patients with SLE and to examine the relationship between cognitive and olfactory function. Methods Fifty-five SLE patients and 50 age- and sex-matched healthy control subjects were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a cognitive screening battery that evaluated five index of cognition including immediate memory (IMME), visuospatial/constructional (Vis/Con), language (LANG), attention (ATT), delayed memory (DEME). Olfactory functions were evaluated using olfactory function assessment by computerized testing including the three stages of smell: threshold (THR), identification (ID) and memory (ME) of the different odors. The disease activity and cumulative damage were assessed by the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology(ACR) Damage Index (SDI). Results Patients with SLE exhibited significant lower total RBANS score, IMME, Vis/Con, ATT and DEME index scores than normal controls (P < 0.01 for all and P = 0.027 for attention). Performances on RBANS immediate memory, language, attention and total scores were correlated with education level of SLE patients. Reduced RBANS index and total scores were associated with several organ involvement and autoantibodies. SLE patients with higher SLEDAI-2K scores or with accumulated damage (SDI≥1) showed decreased RBANS scores than patients with lower SLEDAI-2K scores or without accumulated damage. All the olfactory scores (THR, ID and ME) in patients with SLE were significantly decreased than the control group (all P = 0.001). Patients had higher proportion of anosmia (8.57% vs 0%) and hyposmia (28.58% vs 5.72%) than controls (χ2 = 10.533, P = 0.015). Multivariable regression analysis revealed that olfactory threshold, identification and memory had a positive effect on RBANS index score. Olfactory memory and total score were significantly correlated with the RBANS delayed memory (r = 0.393, P = 0.021) and total scores (r = 0.429, P = 0.011).Conclusion The results of this study indicate that significantly correlated cognitive and olfactory functions are impaired in SLE patients. The RBANS is a potentially useful instrument for evaluating neuropsychological status in SLE. Physicians are encouraged to perform routine screening in patients with SLE to detect subtle cognitive dysfunction and strategize early treatment options.

scholarly journals FRI0606-HPR REMISSION IN SYSTEMIC LUPUS ERYTHEMATOSUS, WHAT IS THE IMPACT ON ACCUMULATED DAMAGE?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 908.3-909
Author(s):  
F. J. Hüttmann ◽  
A. L. Barbaglia ◽  
L. Gonzalez Lucero ◽  
H. R. Sueldo ◽  
M. C. Bertolaccini ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Logistic Regression Model ◽  
Immunosuppressive Drugs ◽  
Systemic Lupus ◽  
Accumulated Damage ◽  
Baseline Visit

Background:The objective of the treatment in rheumatic diseases is to achieved the remission or minimal disease activity of these patients. Previous studies in Systemic Lupus Erythematosus (SLE) showed that reaching remission had a positive impact on the prognosis of the disease.Objectives:To determine the frequency of remission in a cohort of patients with SLE.To evaluate the effect of disease activity on accrual damage.Methods:A retrospective study was carried out from January 2010 to December 2018. Clinical records of patients with SLE (ACR criteria 1982/97) were reviewed considering baseline visit as the first clinical or control visit of 2010. For subsequent visits, data were collected annually until 2018. SLE activity was defined for each visit according to GLADEL´s definition: 1- Remission Without Treatment (RwT): SLEDAI 0, without prednisone or immunosuppressive drugs (IS); 2- Remission on Treatment (RoT): SLEDAI 0, prednisone up to 5mg/day or immunosuppressive drugs in maintenance doses; 3- LDAS (Low Disease Activity Status): SLEDAI ≤ 4, prednisone up to 7.5mg/ ay and/or IS in maintenance doses; 4- Non-Optimal Activity Control (NOC): SLEDAI> 4, prednisone> 7.5 mg/day and/or IS in induction dose. The use of hydroxychloroquine was allowed for all groups. For the analysis, patients who remained in remission (with and without treatment) or LDAS for at least 75% of the follow-up time were grouped and compared with patients who remained active during that same period. Demographic, laboratory, treatment related variables and death were studied. Accrual damage was assessed with SLICC / SDI. Patients with less than two annual visits were excluded.Statistical analysis: descriptive measures, Test T, Mann Whitney, Chi2 Test, Fisher’s exact test, bivariate correlation, logistic regression model with mixed effects.Results:Two hundred eighty-five medical records were reviewed and 100 patients with SLE were included, 89% women, mean age at baseline visit 38.5 ± 12 years old and mean time of disease 9.3 ± 7.3 years. The average SLEDAI and SLICC/SDI baseline scores were 3.7 and 0.8 respectively. The SLICC/ SDI score at last visit was 2.2 and the average SLICC/SDI change (ΔSLICC) compared to baseline visit score was 1.4 ± 1.6.The prevalence of patients who were in remission for at least 75% of the follow-up time was 38% [95% CI 26.6, 45.4]. NOC patients categorized at baseline visit had the highest ΔSLICC (p 0.0001). The ΔSLICC was significantly lower in patients who were at least 75% of the follow-up time in remission (p 0.01) or LDAS (p 0.01) compared to those with NOC. In the Logistic Regression Model, the chance of changing the SLICC/SDI score was 2.9 times higher for the NOC group than for RwT.Conclusion:The frequency of remission in this cohort of patients with SLE was 38%.Worse control of disease activity, was associated with higher accumulated damage.Disclosure of Interests:None declared

Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia

Lupus ◽  
2019 ◽  
Vol 28 (7) ◽  
pp. 854-861 ◽  
Author(s):  
A Kanapathy ◽  
N R Nik Jaafar ◽  
S S Shaharir ◽  
L F Chan ◽  
M Rozita ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cognitive Impairment ◽  
Confidence Interval ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Educational Level ◽  
Cognitive Assessment ◽  
Associated Factors ◽  
Male Gender ◽  
Systemic Lupus

Introduction Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden. Aims This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia. Methods A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong–Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI). Results The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender ( p = 0.04), educational level ( p = 0.00), WBFPS score ( p = 0.035) and anticardiolipin IgM ( p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06–52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47–13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45–32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment. Conclusion Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.

scholarly journals FRI0602-HPR PERSISTENT HYPOCOMPLEMENTEMIA IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 907.2-907
Author(s):  
M. L. Leguizamón ◽  
Y. Soria Curi ◽  
S. M. Mazza ◽  
G. V. Espasa ◽  
F. J. Hüttmann ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Autoantibody Production ◽  
Evolution Time ◽  
Accumulated Damage ◽  
Clinical Records

Background:Systemic lupus erythematosus (SLE) is a systemic, chronic, autoimmune disease of unknown cause characterized by a wide variety of clinical manifestations and autoantibody production. The complement is useful in the initial diagnosis, as an activity marker and for the follow-up of patients with SLE. Individual components may fluctuate only slightly with disease activity and C4 may even remain low during remission. Hypocomplementemia is associated with renal involvement, cutaneous vasculitis, diffuse alveolar hemorrhage, however, patients with persistent hypocomplementemia are not characterized yet.Objectives:1) Determine the prevalence of persistent hypocomplementemia in patients with SLE.2) Identify clinical characteristics, disease activity and accumulated damage in these patients.Methods:A longitudinal study was conducted with a review of the medical records of patients diagnosed with SLE (ACR criteria 82/97) who attended the Rheumatology Service between January 2000 and December 2015. Patients with a minimum evolution time of 6 months from the diagnosis of SLE with quarterly controls and monitoring for 2 years. Persistent Hypocomplementemia (PHC) was defined at C3 and / or C4 values below the normal range of the reference laboratory in a sustained form for at least 24 months. Demographic variables, clinical manifestations, disease activity by SLEDAI 2k, flare by SELENA SLEDAI and accumulated damage by SLICC / SDI were analyzed.Results:Clinical records of 254 patients with SLE were reviewed and 144 were included; 96% were women, with a mean age at diagnosis of SLE of 30.5 ± 11.2 years and a time of evolution of the disease at the last control 11.85 ± 7.8 years. Forty-one patients had PHC (28.5%; 95% CI 21.1, 35.8). The median of evolution time disease at the moment of PHC was 1 year (0-24) and the mean time of persistence of hypocomplementemia was 56 ± 46 months. In the univariate analysis, PHC was associated with hematological involvement during the course of the disease (p=0.01). Patients with PHC had a higher frequency of severe flare during follow-up (p=0.02). PHC was not associated with age of onset of SLE, disease activity (maximum SLEDAI reached), accumulated damage or death. Applying Logistic Regression Model with dependent variables with a level of significance <0.25, PHC was associated independently with hematological compromise (OR 3.2).Conclusion:In this cohort of patients, the prevalence of PHC was 28.5%. PHC was associated with severe flare and hematological compromise.Disclosure of Interests:None declared

“Subcortical” cognitive impairment in patients with systemic lupus erythematosus

2000 ◽  
Vol 6 (7) ◽  
pp. 821-825 ◽  
Author(s):  
ELIZABETH LERITZ ◽  
JASON BRANDT ◽  
MELISSA MINOR ◽  
FRANCES REIS-JENSEN ◽  
MICHELLE PETRI
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cognitive Impairment ◽  
Lupus Erythematosus ◽  
Systemic Lupus

Assessment of Quality of Life (QoL) in Systemic Lupus Erythematosus Patients at a Tertiary Care Hospital in Egypt

2019 ◽  
Vol 15 (4) ◽  
pp. 304-311
Author(s):  
Mervat E. Behiry ◽  
Sahar A. Ahmed ◽  
Eman H. Elsebaie
Keyword(s):  
Quality Of Life ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Tertiary Care ◽  
Damage Index ◽  
Life Questionnaire ◽  
Care Hospital ◽  
Systemic Lupus

: Systemic Lupus Erythematosus (SLE) has a profound impact on quality of life. Objective: The objective of this study was to explore the quality of life among Egyptian SLE patients and to assess its relationships with demographic and clinical features. Methods: One hundred sixty-four SLE patients were recruited for this study. Demographic information; clinical parameters; disease activity, as evaluated by the systemic lupus erythematosus Disease Activity Index; and organ damage, as assessed by the systemic lupus international Collaborative Clinics/American College of Rheumatology Damage Index, were reported. Quality of life was assessed with a quality of life questionnaire specifically designed for patients with systemic lupus erythematosus; the questions are grouped in the following six domains: physical function, sociooccupational activities, symptoms, treatment, mood, and self-image. Higher values indicate poorer quality of life. Conclusion: Poor quality of life among Egyptian SLE patients and disease activity are strongly related to impaired lifestyles in these patients.

Impact of markers of endothelial injury and hypercoagulability on systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (2) ◽  
pp. 182-190
Author(s):  
W Batista Cicarini ◽  
R C Figueiredo Duarte ◽  
K Silvestre Ferreira ◽  
C de Mello Gomes Loures ◽  
R Vargas Consoli ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Endothelial Injury ◽  
Control Group ◽  
Systemic Lupus ◽  
Low Concentrations ◽  
The Relationship

We have explored the relationship between possible hemostatic changes and clinical manifestation of the systemic lupus erythematosus (SLE) as a function of greater or lesser disease activity according to Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) criteria. Endothelial injury and hypercoagulability were investigated in patients with SLE by measuring thrombomodulin (TM), D-dimer (DDi) and thrombin generation (TG) potential. A total of 90 participants were distributed into three groups: 1) women with SLE presenting with low disease activity (laSLE) (SLEDAI-2K ≤ 4), 2) women with SLE presenting with moderate to high disease activity (mhaSLE) (SLEDAI-2K > 4), and 3) a control group comprising healthy women. Levels of TM and DDi were higher both in the laSLE and mhaSLE groups compared to controls and in mhaSLE compared to the laSLE group. With respect to TG assay, lagtime and endogen thrombin potential, low concentrations of tissue factor provided the best results for discrimination among groups. Analysis of these data allow us to conclude that TM, DDi and TG are potentially useful markers for discriminating patients with very active from those with lower active disease. Higher SLE activity may cause endothelial injury, resulting in higher TG and consequently a hypercoagulability state underlying the picture of thrombosis common in this inflammatory disease.

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