Low prevalence of neuropsychiatric systemic lupus erythematosus (NPSLE) was found among patients with psychosis and positive antinuclear antibodies (ANA), suggesting there may be a low diagnostic yield for using ANA as a screening test for NPSLE in patients with psychosis, according to study results published in Arthritis Care & Research.
Previous studies have indicated the prevalence of neuropsychiatric events in patients with established SLE, but limited data are available on the use of ANA as a screening test for NPSLE in patients with psychosis. The objective of the current study was to explore the prevalence of NPSLE in patients with psychosis with positive ANA.
The retrospective study included patients with psychosis who were admitted to the mental health service at the Prince of Wales Hospital or the Royal Prince Alfred Hospital in Sydney, Australia, between January 1, 2010 and March 31, 2018.
Of 4766 patients with psychosis, 911 (91%) were tested for ANA; 135 (15%) of the tests were positive for ANA with a titer of or greater than 1:160. In most cases, the ANA pattern was speckled (n=67) or homogeneous (n=37). Testing for ANA was most frequently done as part of the assessment for an organic cause of psychosis (n=85).
At discharge, 4 patients met the criteria for SLE, 2 of whom were diagnosed with NPSLE. Both patients had other clinical manifestations of SLE. The prevalence of NPSLE in patients with psychosis and positive ANA was 1.5% (n=2/135). Overall, among patients with psychosis who were tested for ANA, 0.2% (n=2/911) were diagnosed with NPSLE.
The study had several limitations, including the retrospective design, potential bias secondary to performing ANA testing at the discretion of the physician, and lack of patient follow-up by specialists experienced in the diagnosis of NPSLE.
“Using ANA as a screening test of NPSLE in patients with psychosis is likely to have a very low yield,” the researchers concluded.
Spies MC, Gutjahr-Holland JA, Bertouch JV, Sammel AM. Prevalence of neuropsychiatric lupus in psychosis patients with a positive antinuclear antibody. Arthritis Care Res (Hoboken). Published online October 1, 2020. doi:10.1002/acr.24472