Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageTo examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE).Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate.Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients.Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.Canadian Institutes of Health Research MOP-86526 Medical Research Council, UK U105261167 Lupus UK NIHR/Wellcome Trust Ministry for Health and Welfare, Republic of Korea (Korea Healthcare Technology RD project) A120404 Arthritis Research UK NIHR (Biomedical Research Unit) NIHR Manchester Biomedical Research Centre NIHR/Wellcome Trust Clinical Research Facility at Central Manchester Foundation Trust NIH RR-00046 8-UL-1TR-000150 K24-AR-2318 P60-AR-4464 AR-43727 Arthritis Society Department of Education, Universities, and Research of the Basque Government Danish Rheumatism Association A1028 Novo Nordisk Foundation A05990 Singer Family Fund for Lupus Research Eli Lilly GlaxoSmithKline MedImmune Merck Serono UCB Roche AbbVie GlaskoSmithKlin