TY - JOUR
T1 - Headache in systemic lupus erythematosus
T2 - Results from a prospective, international inception cohort study
AU - Hanly, John G.
AU - Urowitz, Murray B.
AU - O'Keeffe, Aidan G.
AU - Gordon, Caroline
AU - Bae, Sang Cheol
AU - Sanchez-Guerrero, Jorge
AU - Romero-Diaz, Juanita
AU - Clarke, Ann E.
AU - Bernatsky, Sasha
AU - Wallace, Daniel J.
AU - Ginzler, Ellen M.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Merrill, Joan T.
AU - Petri, Michelle
AU - Fortin, Paul R.
AU - Gladman, Dafna D.
AU - Fessler, Barri J.
AU - Alarcõn, Graciela S.
AU - Bruce, Ian N.
AU - Dooley, Mary Anne
AU - Steinsson, Kristjan
AU - Khamashta, Munther A.
AU - Ramsey-Goldman, Rosalind
AU - Manzi, Susan
AU - Sturfelt, Gunnar K.
AU - Nived, Ola
AU - Zoma, Asad A.
AU - Van Vollenhoven, Ronald F.
AU - Ramos-Casals, Manuel
AU - Aranow, Cynthia
AU - Mackay, Meggan
AU - Ruiz-Irastorza, Guillermo
AU - Kalunian, Kenneth C.
AU - Lim, S. Sam
AU - Inanc, Murat
AU - Kamen, Diane L.
AU - Peschken, Christine A.
AU - Jacobsen, Soren
AU - Theriault, Chris
AU - Thompson, Kara
AU - Farewell, Vernon
PY - 2013/11
Y1 - 2013/11
N2 - Objective To examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). Methods A disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations. Results Among the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean ± SD age was 34.6 ± 13.4 years, duration of disease was 5.6 ± 5.2 months, and length of followup was 3.8 ± 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean ± SD 42.5 ± 12.2 versus 47.8 ± 11.3; P < 0.001), and similar differences in physical component scores were seen (38.0 ± 11.0 in those with headache versus 42.6 ± 11.4 in those without headache; P < 0.001). In 56.1% of patients, the headaches resolved over followup. Conclusion Headache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies.
AB - Objective To examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). Methods A disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations. Results Among the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean ± SD age was 34.6 ± 13.4 years, duration of disease was 5.6 ± 5.2 months, and length of followup was 3.8 ± 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean ± SD 42.5 ± 12.2 versus 47.8 ± 11.3; P < 0.001), and similar differences in physical component scores were seen (38.0 ± 11.0 in those with headache versus 42.6 ± 11.4 in those without headache; P < 0.001). In 56.1% of patients, the headaches resolved over followup. Conclusion Headache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies.
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U2 - 10.1002/art.38106
DO - 10.1002/art.38106
M3 - Article
C2 - 24166793
AN - SCOPUS:84886776750
SN - 0004-3591
VL - 65
SP - 2887
EP - 2897
JO - Arthritis and rheumatism
JF - Arthritis and rheumatism
IS - 11
ER -
