Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Attention Deficit and Hyperactivity Disorder Scores Are Elevated and Associated with Disease Activity and Fatigue in Patients with Systemic Lupus Erythematosus.

Garcia,  Ricardo J., Francis,  Lisa, Dawood,  Maha, Ramos,  Irene, Faraone,  Stephen, Perl,  Andras

Purpose:

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune inflammatory disease characterized by predisposition to pro-inflammatory T cell death by necrosis due to mitochondrial dysfunction, oxidative stress, and depletion of intracellular glutathione. The potential benefit of reversing glutathione depletion is being investigated in a double-blind placebo-controlled treatment trial of N-acetylcysteine in patients with stable disease (ClinicalTrials.gov Identifier: NCT00775476). Since disease activity in SLE may result in neuropsychiatric manifestations and N-acetylcysteine has been found to improve memory in animal models (Basic Clin Pharmacol Toxicol. 105:98–104, 2009), we investigated whether disease activity in patients with SLE is associated Attention Deficit Hyperactivity Disorder (ADHD) which may serve as a neuropsychiatric marker and target of treatment.

Patients and Methods:

The validated ADHD Self-Report Scale (ASRS) Symptom Checklist (Psychol Med 35:245-56, 2005; Ann Clin Psychiatry 18:145–148, 2006) was used to evaluate 22 SLE patients at baseline. As a control for biochemical and immunological studies, a healthy donor matched for ethnicity, gender, and age of the SLE patient within 10 years was bled on the same morning and also asked to complete the ASRS checklist. In the SLE group, 20 of 22 patients were Caucasian, one was African American, and one was Asian. In the control group, 21 of the 22 donors were Caucasian and one was Asian. Mean age was 42.27 years (standard deviation, SD= 12.85, range= 21–64) in the SLE group. Mean age was 44.23 years (SD=10.86, range=23–62) in the control group. All patients were female. SLE disease activity was assessed by using the British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Fatigue was estimated using the Fatigue Assessment Scale (J Psychosom Res 54:345–352, 2003).

Results:

The mean ± SD of part A, part B and total ASRS scores were 10.56 ± 5.75, 9.82 ± 6.01 and 20.36 ± 10.32, respectively, in the control population. Using two-tailed t-test, the mean ± SD of part A, part B and total ASRS scores were increased at 17.23 ± 7.77 (p = 0.0001), 14.36 ± 5.89 (p = 0.004) and 31.59 ± 12.69 in the SLE group (p = 0.0004). Using Pearson's correlation, fatigue scores correlated with part A (r = 0.76, p<0.0001), part B (r = 0.44, p=0.04) and total ASRS scores (r=0.68, p=0.0005). SLEDAI correlated with part A (r = 0.50; p=0.02) and total ASRS scores (r=0.48, p=0.02). There was no correlation between BILAG and ASRS scores.

Conclusion:

Elevated ASRS scores indicate the presence of previously unrecognized and clinically significant symptoms of ADHD in patients with SLE relative to healthy controls matched for age, gender, and ethnic background. ADHD symptoms may be a source of cognitive impairment in SLE, which could lead to functional disability. Longitudinal studies are needed to determine if ADHD symptoms predict the subsequent onset of severe neuropsychiatric disorders that frequently follow the onset of idiopathic ADHD in children (Am J Psychiatry 167:409 417, 2010).

To cite this abstract, please use the following information:
Garcia, Ricardo J., Francis, Lisa, Dawood, Maha, Ramos, Irene, Faraone, Stephen, Perl, Andras; Attention Deficit and Hyperactivity Disorder Scores Are Elevated and Associated with Disease Activity and Fatigue in Patients with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :449
DOI: 10.1002/art.28218

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