Hanly JG et al. (2005) Neuropsychiatric syndromes in patients with systemic lupus erythematosus and rheumatoid arthritis. J Rheumatol 32: 1459–1466

Neuropsychiatric syndromes in patients with systemic lupus erythematosus (SLE) might be attributable to non-SLE factors, according to a recent study by Hanly and colleagues. Nervous system involvement is a common feature of SLE; however, few trials have addressed the extent of non-SLE-specific causes of these neuropsychiatric events.

The Canadian study compared the prevalence, diversity and clinical significance of neuropsychiatric syndromes in 53 patients with SLE and 53 patients with rheumatoid arthritis (RA). The demographic features of the two groups were similar.

The trial showed that the number of patients with a neuropsychiatric event was higher in the RA group than the SLE group. With regard to health-related quality of life, fatigue, depression and anxiety, and cognitive dysfunction, there were no significant differences between the two groups. More SLE patients with cumulative neuropsychiatric syndromes, experienced cognitive distress than did RA patients with cumulative neuropsychiatric syndromes, although this did not translate into a lower health-related quality of life.

The finding that anxiety, headache and mood disorders were comparable in both groups is interesting: it suggests that SLE patients are no more likely to experience these symptoms than patients with other chronic rheumatic diseases. The etiology of neuropsychiatric syndromes in patients with SLE is multifactorial, and correctly identifying the cause is a significant challenge. In conclusion, there is sufficient evidence to suggest that in a substantial proportion of patients, neuropsychiatric syndromes are not attributable to SLE.