THU0284 PREVALENCE OF NEUROPSYCHIATRIC LUPUS IN PSYCHOSIS PATIENTS WITH A POSITIVE ANTINUCLEAR ANTIBODY
Authors: M Spies, J Gutjahr-Holland, J. V. Bertouch, A Sammel
Journal: Annals of the Rheumatic Diseases (2020)

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 1 . Current guidelines do not make a recommendation regarding the use of Antinuclear Antibody (ANA) in the assessment of patients with psychosis 2 . There is limited evidence assessing the utility of ANA testing in this setting. Objectives: Primary objective: Determine the prevalence of NPSLE in patients admitted to a mental health service with a diagnosis of a psychosis, who have had a positive antinuclear antibody test. Secondary objectives: Determine the frequency and proportion of positive ANA testing in this patient group. Determine the pattern and titres of positive ANAs. Determine the subsequent investigation, referral and diagnosis of patients with positive ANAs. Methods: Retrospective chart review of patients admitted to a mental health service of two metropolitan tertiary referral centres, Prince of Wales Hospital (POWH) and Royal Prince Alfred Hospital (RPAH), with a diagnosis of psychosis who had been tested for ANA. Patients were identified using their electronically entered diagnosis based on the International Classification of Disease 3 codes. Assessment of patient data for SLE used the 2019 ACR/EULAR classification criteria 4 . Decisions regarding attribution of psychosis related events to SLE follows the criteria used by Bortoluzzi et al 5 . Results: Between 1 st of January 2010 and 31 st of March 2018 there were 5585 (POWH) and 4620 (RPAH) mental health admission with an ICD diagnosis of psychosis representing 2451 and 2315 individual patients. 449/2451 (18%) and 462/2315 (20%) patients were tested for ANA. 78/449 (17%) and 57/462 (12%) were positive. Discharge data was available for all patients and long-term follow up data was completed for 53/78 (81% - POWH) patients and 50/57 (88% - RPAH). The mean follow-up time 43 ± 23 months and 51 ± 29 months respectively. At discharge there were four patients who met 2019 ACR/EULAR for SLE. Of these, two patients met criteria for NPSLE. One was diagnosed clinically and treated specifically for NPSLE with intravenous methylprednisolone and rituximab. There were no additional diagnoses of SLE or NPSLE clinically or by criteria found in the available follow up data. Hence the overall prevalence of NPSLE in patients admitted with psychosis was 1.3%, 95%CI [0,6.9%] and 1.8%, 95%CI [0,9.4%] respectively. Conclusion: The prevalence of neuropsychiatric lupus in patients with psychosis and a positive ANA was 1/78 and 1/57 a two tertiary referral centres. This study expands significantly on the limited evidence available as to the expected outcomes of a positive ANA test in a patient with psychosis. References: [1]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. [2]National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. London: NICE; 2014. Clinical guideline CG178. [3]World Health Organization. (2004). ICD-10: international statistical classification of diseases and related health problems: tenth revision, 2nd ed. [4]Aringer M, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2019; 71(9): 1400–1412. [5]Bortoluzzi A, et al. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatology. 2015; 54: 891-898. Acknowledgments: Gordana Popovic, Statistical Consultant, Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia. Disclosure of Interests: None declared