Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Predictors of Seizures in Systemic Lupus Erythematosus.
Hanly1, John G., Urowitz2, Murray B., Su3, Li, Gordon4, Caroline, Bae5, Sang-Cheol, Sanchez-Guerrero6, Jorge, Romero-Diaz7, Juanita
Dalhousie University and Capital Health, Halifax, NS
McGill UHC/RVH, Montreal, QC
SUNY-Downstate Medical Center, Brooklyn, NY
Oklahoma Medical Research Foundation, Oklahoma City, OK
University College London, London, United Kingdom
Johns Hopkins University School of Medicine, Baltimore, MD
Toronto Western Hospital, Toronto, ON
Toronto Western Hospital, University of Toronto, Toronto, ON
A, Manchester, United Kingdom
Landspital Univ Hospital, Reykjavik, Iceland
University of North Carolina at Chapel Hill, Chapel Hill, NC
Toronto Western Hospital and University of Toronto, Toronto, ON
Lupus Research Unit, The Rayne Institute, Kings College London School of Medicine, London, United Kingdom
University of Alabama at Birmingham, Birmingham, AL
Northwestern University Feinberg School of Medicine, Chicago, IL
Allegheny Singer Research Institute, Pittsburgh, PA
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK, Cambridge, United Kingdom
University of Birmingham, Birmingham, United Kingdom
Hanyang University Hospital for Rheumatic Diseases, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
Mount Sinai Hospital/University Health Network, Toronto, ON
INCMNSZ, Mexico city, Mexico
Cedars-Sinai/UCLA, Los Angeles, CA
Research Institute of the McGill Univ. Health, Montreal, QC
Neuropsychiatric (NP) manifestations of SLE include seizure disorders. Our objective was to determine which clinical and laboratory variables were associated with seizures in a long-term prospective study of SLE patients.
A multi-center, international, research network enrolled patients within 15 months of fulfilling ACR criteria for SLE and performed annual assessments for up to 10 years. Seizures and other NP manifestations were recorded using the ACR case definitions. Decision rules determined the attribution of seizures to SLE and non-SLE causes. Clinical variables included demographic characteristics, disease duration, educational status, medication utilization, global SLE disease activity (SLEDAI-2K) and cumulative organ damage (SLICC/ACR Damage Index (SDI)) computed with and without NP variables. Plasma/serum samples were available at enrollment for the determination of the following autoantibodies: lupus anticoagulant, anticardiolipin, anti-b2 glycoprotein-I, anti-ribosomal P and anti-NR2 glutamate receptor antibodies. The association between clinical and serological variables and the risk of the first occurrence of seizures was examined by univariate and multivariate Cox regression analysis.
The 1631 enrolled patients were predominantly female (89.4%) with a mean (± SD) age of 35.0 ± 13.4 years and mean disease duration of 5.6 ± 4.8 months. The mean followup was 3.5 ± 2.9 years. Over this period 75/1631 (4.6%) patients had >= 1 seizure with a total of 91 seizures of which 78/91 (86%) were attributed to SLE. Multivariate analysis indicated a significantly higher risk of seizures with African race/ethnicity (HR (CI): 1.97 (1.073.63); p=0.02) and lack of post-secondary education (1.97 (1.213.19); p<0.01) after adjustment for age at diagnosis and gender. In order to examine the effect of prior organ damage and medication use, the analysis was restricted to those seizuresoccurring after the enrollment visit (n=20). In these patients higher SDI scores calculated without NP variables were associated with an increased risk of subsequent seizures (SDI=1: 3.71(1.389.95); SDI=2or3: 1.33(0.276.46); SDI>=4: 6.44(0.7257.2); p=0.04). After adjustment for prior medication, this risk was less significant (p=0.07) demonstrating some confounding between disease severity and medication. Prior use of anti-malarial drugs in the absence of immunosuppressive agents was the most notable treatment effect on seizures (0.07 (0.010.66); p=0.02). There was no association with SLEDAI scores or between any of the autoantibodies detected at enrollment with subsequent seizures.
The risk of seizures in SLE patients is higher in patients of African race/ethnicity, lower educational status and organ damage outside of the nervous system. The association with lupus related therapies is complex but anti-malarial drugs may have a protective effect.
To cite this abstract, please use the following information:
Hanly, John G., Urowitz, Murray B., Su, Li, Gordon, Caroline, Bae, Sang-Cheol, Sanchez-Guerrero, Jorge, et al; Predictors of Seizures in Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :592