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Rheumatology Advance Access originally published online on July 25, 2008
Rheumatology 2008 47(10):1498-1502; doi:10.1093/rheumatology/ken260
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease

J. M. Pego-Reigosa1,2 and D. A. Isenberg1

1Centre for Rheumatology Research, University College of London Division of Medicine, London, UK and 2Rheumatology Section, Meixoeiro Hospital, Vigo University Hospital Complex, Vigo, Spain.

Correspondence to: J. M. Pego-Reigosa, Rheumatology Section, Hospital do Meixoeiro (Complexo Hospitalario Universitario de Vigo), Alto do Meixoeiro s/n, 36200 Vigo (Pontevedra), Spain. E-mail: jose.maria.pego.reigosa{at}sergas.es


  Abstract

Objective. To determine the prevalence, characteristics and long-term outcome of psychosis due to SLE defined according to the ACR nomenclature for neuropsychiatric (NP) syndromes.

Methods. All the patients who strictly fulfilled the ACR definition for psychosis due to lupus were identified within the 485 patients of our lupus cohort and retrospectively evaluated.

Results. Psychosis due to lupus was diagnosed in 11 (2.3%) patients. Lupus psychosis presented as the initial presentation of SLE in 60% of the patients and within the first year of the disease in 80% of the cases. All the patients developed psychotic symptoms within the context of multi-systemic lupus activity, with 90% of them having cutaneous involvement. Psychosis activity in our patients was associated with biological markers of lupus activity in 90% of the cases. The aPLS were observed in 10% of the cases. Seventy percent of our patients showed complete resolution of psychotic symptoms after a mean follow-up of 155 months. Long-lasting remissions were seen in all those patients. Chronic mild psychotic symptoms were observed in 30% of our patients.

Conclusion. Psychosis due to lupus is an uncommon event that usually occurs early in the course of the disease and is associated with other clinical and biological features of SLE. Long-term outcome appears to be favourable after intensive immunosuppressive treatment. This report highlights the need for prospective multi-centre studies to improve our knowledge and to help establish guidelines for the treatment of this rare complication of lupus.

KEY WORDS: Systemic lupus erythematosus, Neuropsychiatric lupus, Psychosis, Prevalence, Outcome

Submitted 27 February 2008; revised version accepted 17 June 2008.
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