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.


Autoantibodies as Biomarkers for the Prediction of Neuropsychiatric Events in Systemic Lupus Erythematosus.

Hanly2,  John G., Urowitz20,  Murray B., Su13,  Li, Cheol-Bae6,  Sang, Gordon26,  Caroline, Sanchez-Guerrero7,  Jorge, Clarke12,  Ann

Capital Health, Halifax, NS, Canada
Landspitali University Hospital, Reykjavik, Iceland
Medical University of South Carolina, Charleston, SC
Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, United Kingdom
Northwestern University and Feinberg School of Medicine, Chicago, IL
Oklahoma Medical Research Foundation, Oklahoma City, OK
Servicio Enfermedades Autoinmunes Hospital Clínico y Provincial, Barcelona, Spain
SUNY Downstate Medical Center, Brooklyn, NY
The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, United Kingdom
The University of Manchester, Manchester, United Kingdom
Capital Health and Dalhousie University, Halifax, NS, Canada
Toronto Western Hospital and University of Toronto, ON, Canada
UCSD School of Medicine, La Jolla, CA
Universidad del Pais Vasco, Barcelona, Spain
University College, London, United Kingdom
University Hospital Lund, Lund, Sweden
University of Alabama at Birmingham, Birmingham, AL
University of Birmingham, Birmingham, United Kingdom
University of Manitoba, Winnipeg, Canada
University of North Carolina, Chapel Hill, NC
University of Pittsburgh School of Medicine, Pittsburgh, PA
Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA
Columbia University Medical Center, New York, NY
Emory University, Atlanta, GA
Hanyang University Hospital for Rheumatic DIseases, Seoul, Korea
Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico
John Hopkins University School of Medicine, Baltimore, MD
Karolinska Institute, Stockholm, Sweden

Purpose:

Neuropsychiatric (NP) events are frequent in patients with systemic lupus erythematosus (SLE) and can occur unpredictably at any time over the disease course. The availability of validated biomarkers for NP events would be advantageous. Our objective was to determine if the presence of selected autoantibodies at enrollment predicted the occurrence of NP events in a large disease inception cohort of SLE patients.

Methods:

The study was conducted by an international research network of 30 academic centers. Patients were enrolled within 15 months of SLE diagnosis and assessed annually for up to 10 years for the occurrence of NP events using the ACR case definitions for 19 NP syndromes. These were categorized into diffuse/focal and central/peripheral NP events. Decision rules of different stringency (model A and model B) were used to determine the attribution of NP events to SLE and non-SLE causes. Plasma/serum samples were available from 1047 patients for the determination of the following autoantibodies in a central laboratory: lupus anticoagulant, IgG anticardiolipin, anti-b2 glycoprotein-I, anti-ribosomal P and anti-NR2 glutamate receptor antibodies. The association between the presence of autoantibodies and the risk of the first occurrence of NP events was examined by Cox regression.

Results:

Of the 1047 patients 89.1% were female and the mean (± SD) age was 35.2 ± 13.7 years. The mean disease duration at enrollment was 5.4 ± 4.2 months and the mean length of followup was 3.27 ± 2.8 years. Over the period of study 495/1047 (47.3%) patients had 1 or more NP events (total of 917 events) encompassing 17 of 19 NP syndromes. The proportion of NP events attributed to SLE varied from 15.4% (model A) to 28.2% (model B). The frequency of autoantibodies at enrollment was 21.9% (lupus anticoagulant), 13.4% (anticardiolipin), 15.1% (anti-b2-GPI), 9.2% (anti-ribosomal P) and 13.7% (anti-NR2 antibodies). There was no significant positive association between any of the autoantibodies and first occurrence of NP events overall, or events attributed to SLE (model A or model B). Clustering of NP events into diffuse/focal and central/peripheral manifestations did not change the outcome. However, LA at baseline was associated with the occurrence of stroke/sinus thrombosis (total n=22) attributed to SLE (model B) (Hazard ratio (95% CI): 2.54 (1.08–5.94); p=0.03). Furthermore anti-ribosomal P antibodies at enrollment were associated with psychosis (total n=14) attributed to SLE (model B) (Hazard ratio (95% CI): 3.92 (1.23–12.5); p=0.02).

Conclusion:

The detection of LA and anti-ribosomal P antibodies near the time of diagnosis of SLE is associated with an increased risk for intra-cranial thrombosis and lupus psychosis respectively.

To cite this abstract, please use the following information:
Hanly, John G., Urowitz, Murray B., Su, Li, Cheol-Bae, Sang, Gordon, Caroline, Sanchez-Guerrero, Jorge, et al; Autoantibodies as Biomarkers for the Prediction of Neuropsychiatric Events in Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2243
DOI: 10.1002/art.30006

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