Major Finding: A score of 17 or higher on a 27-question survey being developed in Europe is 92.9% sensitive and 25.5% specific for NPSLE.
Data Source: To determine sensitivity and specificity, the survey was administered to 139 people with SLE, 58 previously diagnosed with neuropsychiatric complications.
Disclosures: The researchers said they have no relevant conflicts of interest. The study was funded by their institution.
VANCOUVER, B.C. — A short questionnaire promises to be a simple way to identify neuropsychiatric involvement in patients with systemic lupus erythematosus. Affected individuals need referral and specialized treatment.
A score higher than 17 on the questionnaire is 92.9% sensitive (95% confidence interval [CI], 85.1%-97.3 %) and 25.5% specific (95% CI, 14.7%-39.0%) for neuropsychiatric systemic lupus erythematosus (NPSLE), according to Dr. Stefano Bom-bardieri, chairman of the department of internal medicine and professor of rheumatology at the University of Pisa (Italy), who presented the findings at the international congress.
The questionnaire appears to be “able to identify patients that should be referred for further assessment,” he said.
Dr. Bombardieri's conclusion is based on administration of the questionnaire to 139 SLE patients, 58 of whom had been previously diagnosed with NPSLE.
The screening tool contains 27 questions for patients to answer about their CNS and psychiatric health. A few questions have yes/no answers. The majority have “always,” “often,” “sometimes,” and “never” answers. The questions are weighted for scoring purposes.
“It is very simple and requires about 8 minutes to complete. We have been using the questionnaire but have not yet validated it,” said Dr. Marta Mosca, also of the University of Pisa.
This is the first such screening tool developed for NPSLE, to the best of her knowledge, said Dr. Mosca.
To validate the questionnaire, patients with a score suggestive of NPSLE will then be assessed for NPSLE according to recently published European League Against Rheumatism guidelines. The goal is to see if the survey over- or underestimates the condition (Ann. Rheum. Dis. 2010;69:1,269-74).
Pending that work, and pending publication of the questionnaire in a medical journal, the doctors were reluctant to allow earlier publication.
But the questions are in keeping with those on neurologic and psychiatric assessments used by other professions. Among them:
▸ Do you frequently suffer from headaches (more than once monthly)?
▸ Have you experienced in the last 3 months, without warning, a sudden loss of power or sensation in an arm or of a leg?
▸ In the last 3 months, have you had any problems in recalling familar faces, travel routes, or images?
▸ In the last 3 months, have you felt afraid for no reason at all?
Neuropsychiatric involvement is common in SLE, with a reported prevalence ranging from 14% to 80%.
It can include headache, seizures, cerebrovascular disease, psychosis, cranial neuropathy, mood disorders, cognitive dysfunction, movement disorders, and other manifestations, depending on what part of the CNS is attacked by the disease, according to Dr. Bombardieri.
The onset of manifestations is often insidious, and subtle symptoms might be overlooked by the physician or by the patient.
Psychiatric manifestations, in particular, persist when disease is inactive, he said.
Diagnosis is difficult. “There is no consensus on the role of laboratory, imaging, and other diagnostic procedures,” Dr. Bombardieri said.
And yet, early recognition and treatment are the keys to reducing long-term damage and complications, he added.
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