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Time to neuropsychiatric damage occurrence in LUMINA (LXVI): a multi-ethnic lupus cohort

Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama

GJ Pons-Estel

Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama

J Zhang

Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama

LM Vilá

Department of Medicine (Division of Rheumatology), The University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico

JD Reveille

Department of Medicine (Division of Rheumatology), The University of Texas Health Science Center at Houston, Houston, Texas

GS Alarcón

Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabamagraciela.alarcon{at}ccc.uab.edu

for the LUMINA study group

The aims of this study were to examine the predictors of time to neuropsychiatric (NP) damage and its impact on mortality in 632 systemic lupus erythematosus African-American, Hispanic and Caucasian LUpus in MInorities: NAture versus Nurture (LUMINA) patients, age  16 years and disease duration 5 years at baseline (T0). Time-to-NP damage and its impact on mortality were examined by Cox proportional hazards regressions. A total of 185 (29.3%) patients developed NP damage over a mean (SD) disease duration of 5.6 (3.7) years. After adjusting for NP manifestations present, older age [Hazard ratio (HR) = 1.02; 95% Confidence interval (CI) 1.00–1.04], Caucasian ethnicity (HR = 1.87; 95% CI, 1.22–2.87), disease activity over the disease course (HR = 1.16; 95% CI, 1.12–1.21), diabetes (HR = 3.47; 95% CI, 1.44–8.38) and abnormal illness-related behaviours (HR = 1.05; 95% CI, 1.02–1.08) were associated with a shorter time-to-NP damage. Photosensitivity (HR = 0.65; 95% CI, 0.44–0.95), anaemia (HR = 0.56; 95% CI, 0.31–0.98), Raynaud’s phenomenon (HR = 0.49; 95% CI, 0.34–0.72), a medium dose of prednisone (HR = 0.56; 95% CI, 0.35–0.92) and hydroxychloroquine use (HR = 0.58; 95% CI, 0.36–0.93) were associated with a longer time. NP damage did not contribute to mortality. Older age, Caucasian ethnicity, disease activity and abnormal illness-related behaviours are associated with a shorter time-to-NP damage; hydroxychloroquine and a medium dose of prednisone with a longer time.

Key Words: damage • neuropsychiatric lupus • systemic lupus erythematosus

Lupus, Vol. 18, No. 9, 822-830 (2009)
DOI: 10.1177/0961203309104392


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