Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Suicidal Ideation Common in Childhood-Onset Systemic Lupus Erythematosus (cSLE); Genetic Expression and Depressive Symptoms in cSLE
Nassi1, Lorien A., Punaro1, Marilynn G., Morton1, Anne, Fribley2, Corinne, Baisch3, Jeanine, Xu3, Zhaohui, Pascual3, M. Virginia
Interferon (IFN) alpha plays an important pathogenic role in cSLE. People receiving alpha interferon (for hepatitis C, e.g.) have been noted to have depression. The purpose of this study is to determine the frequency of depressive symptoms in cSLE, and its relationship to IFN alpha signature.
40 unselected consecutive cSLE subjects (ages 1318) were recruited for this study at our institution. Subjects completed the Children's Depression Inventory (CDI) at routine clinic visits, minimally 3 months apart, for three consecutive visits. Blood samples for gene expression studies were obtained at each visit, total RNA was isolated, and samples were analyzed using Illumina Human Ref8 BeadChips.
34 subjects have completed 3 study visits. 86% were female, mean age was 15.3 years, mean duration of SLE was 3.7 years, and 64% were Hispanic, 19% were African American, 11% were Caucasian, and 5% were Asian. Average SLEDAI score was 6.1, 64% were taking corticosteroids, 25% were receiving high-dose "pulse" corticosteroids, 94% had renal disease, 11% had been diagnosed with a mood disorder, and an additional 5.6% had other CNS disease.
Average CDI score for first time point was 4.6 (general adolescent population = 9). 19% admitted to some degree of suicidal ideation over the previous 2 wks, while 22% had a CDI score of 12 or greater (1 std above mean). 33% were evaluated by psychology/psychiatry. Not all subjects with suicidal ideation had elevated CDI scores.
A weak correlation between CDI and SLEDAI scores was found (R2= 0.12, p = 0.03). No significant correlation between interferon alpha-inducible gene expression and CDI scores was found (M1.2 r =-0.04, p = 0.84, M3.4 r =-0.04, p = 0.81, M5.12 r =-0.06, p =-0.76.) Microarray analysis did identify 9 groups of transcriptionally co-regulated transcripts (modules) with unknown biological function that correlated with CDI scores (M7.26 r = 0.35, p = 0.04, M8.10 r = 0.40, p = 0.02, M8.14 r = 0.36, p = 0.04, M8.29 r = 0.42, p = 0.01, M8.88 r = 0.36, p = 0.04, M8.97 r = 0.40, p = 0.02, M9.1 r = 0.39, p = 0.02, M9.42 r = 0.44, p = 0.01, M9.46 r = 0.43, p = 0.01.)
A significant fraction (19%) of children with SLE had some degree of suicidal ideation in the 2 weeks previous to our evaluation. 33% admitted symptoms prompting psychiatric evaluation. Genomic studies showed that although there was no correlation between CDI scores and individual interferon alpha signatures, expression of a series of co-regulated transcripts of unknown biological function did correlate with these scores. This study suggests that screening for depressive symptoms and suicidal ideation should be performed in children with SLE. Although preliminary, our data suggests that blood gene expression signatures might be used to monitor depression symptoms in patients with SLE.
To cite this abstract, please use the following information:
Nassi, Lorien A., Punaro, Marilynn G., Morton, Anne, Fribley, Corinne, Baisch, Jeanine, Xu, Zhaohui, et al; Suicidal Ideation Common in Childhood-Onset Systemic Lupus Erythematosus (cSLE); Genetic Expression and Depressive Symptoms in cSLE [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1532