Oral Presentation ARA-NSW 2019 - 41st Annual NSW Branch Meeting

Prevalence of clinically relevant positive antinuclear antibody tests in patients with psychosis related disorder (#13)

Michael C Spies 1 2 3 , Johannes A Gutjahr-Holland 1 , Anthony M Sammel 2 , Jim V Bertouch 2
  1. NSW Health, Sydney, NSW, Australia
  2. Department of Rheumatology, Prince of Wales Hospital, Randwick, NSW, Australia
  3. Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

Background: Psychosis is a rare manifestation of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). Patients with SLE may have Psychosis as part of their initial presentation of disease. The current Royal Australia and New Zealand College of Psychiatrists guidelines for assessment and investigation for people presenting with psychosis does not make a recommendation regarding the use of Antinuclear Antibody (ANA). Our aim is to determine the prevalence of a clinically relevant positive antinuclear antibody test in patients admitted to mental health service with a diagnosis of a psychosis related disorder, who have been tested for antinuclear antibodies.

 

Methods: Retrospective review of patient data admitted to the mental health service with a diagnosis of a psychosis related disorder over 8 years of presentation to two different centres. For patients tested who return a positive ANA, medical records will be reviewed and medical practitioner contacted if required to determine final medical and psychiatric diagnosis. Data entry allows for the assessment of possible connective tissue disease, specifically lupus, using the revised ACR and SLICC classification criteria as well as SLEDAI/SLEDAI-2K activity index. Decisions regarding attribution of psychosis related events to SLE follows the criteria used in the SLICC inception cohort.

 

Results: There were 1629 patients having a total of 3819 encounters at the first centre. ANA was tested on 285 (17%) patients during these encounters, 50 (21%) testing positive, representing 3% of 1629 patients. There were no cases which were associated or attributed to SLE. Follow-up data is nearing completion, to date there was no SLE or other connective tissue disease diagnosed during the follow-up period. Second site data collection pending.

 

Conclusions: To be determined

  1. Hanly JG, Urowitz MB, Sanchez-Guerrero J, et al. Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: an international inception cohort study. Arthritis Rheum 2007; 56: 65–273.
  2. Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29; 288-291
  3. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999; 42:599–608.
  4. Pego-Reigosa JM, Isenberg DA. Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease. Rheumatology (Oxford). 2008; 47:1498–502.
  5. Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry. 2016; 50(5): 1-117.
  6. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;1725
  7. Petri M, Orbai AM, Alarcon GS, Gordon C, Merril JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum, 64 (2012), pp. 2677-2686
  8. Hanly JG, Li Q, Su L, et al. Psychosis in Systemic Lupus Erythematosus: Results from an International Inception Cohort Study. Arthritis Rheumatol. 2019; 71(2): 281-289.