Evidence map›Paper›PMID 38518094›Full record

ArticleRheumatology (Oxford, England)2025

Neuropsychiatric symptoms in systemic lupus erythematosus: mixed methods analysis of patient-derived attributional evidence in the international INSPIRE project.

Melanie Sloan, Thomas A Pollak, Efthalia Massou, Guy Leschziner, Laura Andreoli, Rupert Harwood, Michael Bosley, Mervi Pitkanen, Wendy Diment, Alessandra Bortoluzzi and 10 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
2.8field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 11 institutions in 5 countries.

Melanie SloanDepartment of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK.
Thomas A PollakInstitute of Psychiatry, Psychology and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, London, UK.
Efthalia MassouDepartment of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK.
Guy LeschzinerDepartment of Neurology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
Laura AndreoliUnit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy.ORCID 0000-0002-9107-3218
Rupert HarwoodSwansea University Medical School, Swansea, Wales.
Michael BosleyPatient and Public Co-Investigators.
Mervi PitkanenInstitute of Psychiatry, Psychology and Neuroscience, King's College London, and South London and Maudsley NHS Foundation Trust, London, UK.
Wendy DimentPatient and Public Co-Investigators.
Alessandra BortoluzziRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy.
Michael S ZandiDepartment of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK.ORCID 0000-0002-9612-9401
Mandeep UbhiRheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Caroline GordonRheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.ORCID 0000-0002-1244-6443
David JayneDepartment of Medicine, University of Cambridge, UK.
Felix NaughtonBehavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK.ORCID 0000-0001-9790-2796
Colette BarrereSwansea University Medical School, Swansea, Wales.
Chris WincupDepartment of Rheumatology, Kings College Hospital, London, UK.ORCID 0000-0002-8742-8311
James BrimicombeDepartment of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK.ORCID 0000-0002-3443-3256
James A BourgeoisDepartment of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA, USA.
David D'CruzThe Louise Coote Lupus Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
University of Cambridge · GBKing's College London · GBSt Thomas' Hospital · GBSwansea University · GBUniversity of Birmingham · GBBrescia University · USKing's College - North Carolina · USQueen Mary University of London · GBUniversity of California Davis Medical Center · USUniversity of East Anglia · GBUniversity of Ferrara · IT

Funding

Biomedical Research Centre at South London and MaudsleyDepartment of Health and Social CareFoundation Trust and King's College LondonINSPIRENational Institute for Health ResearchNHSThe Lupus Trust
6 · The paper itself

Abstract

objectiveAttribution of neuropsychiatric symptoms in systemic lupus erythematosus (SLE) relies heavily on clinician assessment. Limited clinic time, variable knowledge and symptom under-reporting contribute to discordance between clinician assessments and patient symptoms. We obtained attributional data directly from patients and clinicians in order to estimate and compare potential levels of direct attribution to SLE of multiple neuropsychiatric symptoms using different patient-derived measures.

methodsQuantitative and qualitative data analysed included: the prevalence and frequency of neuropsychiatric symptoms, response to corticosteroids and concurrence of neuropsychiatric symptoms with non-neuropsychiatric SLE disease activity. SLE patients were also compared with controls and inflammatory arthritis (IA) patients to explore the attributability of neuropsychiatric symptoms to the direct disease effects on the brain/nervous system.

resultsWe recruited 2817 participants, including 400 clinicians. SLE patients (n = 609) reported significantly higher prevalences of neuropsychiatric symptoms than controls (n = 463) and IA patients (n = 489). SLE and IA patients' quantitative data demonstrated multiple neuropsychiatric symptoms relapsing/remitting with other disease symptoms such as joint pain. Over 45% of SLE patients reported resolution/improvement of fatigue, positive sensory symptoms, severe headache, and cognitive dysfunction with corticosteroids. Evidence of direct attributability in SLE was highest for hallucinations and severe headache. SLE patients had greater reported improvement from corticosteroids (p= 0.008), and greater relapsing-remitting with disease activity (P < 0.001) in the comparisons with IA patients for severe headache. Clinicians and patients reported insufficient time to discuss patient-reported attributional evidence. Symptoms viewed as indirectly related/non-attributable were often less prioritized for discussion and treatment.

conclusionWe found evidence indicating varying levels of direct attributability of both common and previously unexplored neuropsychiatric symptoms in SLE patients, with hallucinations and severe headache assessed as the most directly attributable. There may also be-currently under-estimated-direct effects on the nervous system in IA and other systemic rheumatological diseases.

Indexed as

Lupus Erythematosus, SystemicLupus Vasculitis, Central Nervous SystemAdrenal Cortex HormonesAdultCognitive DysfunctionFatigueFemaleHeadacheHumansMaleMiddle AgedPrevalenceSeverity of Illness IndexAdrenal Cortex HormonesattributionautoimmunitybiopsychosocialCNS lupusdiagnosisinflammatory arthritismental healthmisattributionneuropsychiatric lupusNPSLEpatient-clinician interactionsrheumatologySLE

Identifiers

PMID38518094
PMCPMC11879331
OpenAlexW4393097411

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.