Abstract
Forty-five systemic lupus erythematosus (SLE) patients who had steroid at a prednisolone dose of 0.8 mg/kg/day or more were retrospectively studied for psychiatric events that developed after the therapy. Simple insomnia was excluded. Their age, sex, dose, and duration of steroid, autoantibodies, and prophylactic heparin use were examined. Seventeen patients (female/male: 16/1, 36.7 ± 10.7 years old) developed psychiatric events 18.2 ± 10.2 days after steroid start, whereas 28 patients (27/1, 37.9 ± 13.1) did not. Anti-SS-A (Ro) antibody was more prevalent in patients with the events (15/17 vs. 14/28, p = 0.009). When heparin was administered concurrently with steroid, psychiatric events developed less frequently either in all of the patients (2/17 vs. 11/28, p = 0.048) or in patients positive for the anti-SS-A antibody (2/15 vs. 7/14, p = 0.041). SLE patients positive for the anti-SS-A (Ro) antibody would much more likely develop psychiatric events after a substantial-dose steroid therapy, and a concurrent prophylactic heparin administration might reduce the risk.
Similar content being viewed by others
References
Wolkowitz OM, Reus VI, Canick J, Levin B, Lupien S (1997) Glucocorticoid medication, memory and steroid psychosis in medical illness. Ann N Y Acad Sci 823:81–96
Patten SB, Neutel CI (2000) Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf 22:111–122
Warrington TP, Bostwick JM (2006) Psychiatric adverse effects of corticosteroids. Mayo Clin Proc 81:1361–1367
Sergent JS, Lockshin MD, Klempner MS, Lipsky BA (1975) Central nervous system disease in systemic lupus erythematosus. Am J Med 58:644–654
Joffe RT, Denicoff KD, Rubunow DR, Tsokos G, Balow JE, Pillemer SE (1988) Mood effects of alternate-day corticosteroid therapy in patients with systemic lupus erythematosus. Gen Hosp Psychiatry 10:56–60
van Dam AP (1991) Diagnosis and pathogenesis of CNS lupus. Rheumatol Int 11:1–11
Boston Collaborative Drug Surveillance Program (1972) Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther 13:694–698
Chau SY, Mok CC (2003) Factors predictive of corticosteroid psychosis in patients with systemic lupus erythematosus. Neurology 61:104–107
Joffe RT, Wolkowitz OM, Rubinow DR, Denicoff K, Tsokos G, Pillemer S (1988) Alternate-day corticosteroid treatment, mood and plasma HVA in patients with systemic lupus erythematosus. Neuropsychobiology 19:17–19
Wolkowitz OM, Sutton ME, Doran AR, Labarca R, Roy A, Thomas JW, Pickar D, Paul SM (1995) Dexamethasone increases plasma HVA but not MHPG in normal humans. Psychiatry Res 16:101–109
Inoue T, Koyama T (1996) Effects of acute and chronic administration of high-dose corticosterone and dexamethasone on regional brain dopamine and serotonin metabolism in rats. Prog Neuropsychopharmacol Biol Psychiatry 20:147–156
Bonfa E, Golombek SJ, Kaufman LD, Skelly S, Weissbach H, Brot N, Elkon KB (1987) Association between lupus psychosis and anti-ribosomal P protein antibodies. N Engl J Med 317:265–271
Schneebaum AB, Singleton JD, West SG, Blodgett JK, Allen LG, Cheronis JC, Kotzin BL (1991) Association of psychiatric manifestations with antibodies to ribosomal P proteins in systemic lupus erythematosus. Am J Med 90:54–62
Isshi K, Hirohata S (1996) Association of anti-ribosomal P protein antibodies with neuropsychiatric systemic lupus erythematosus. Arthritis Rheum 39:1483–1490
ACR ad hoc committee on neuropsychiatric lupus nomenclature (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42:599–608
Drosos AA, Angelopoulos NV, Liakos A, Moutsopoulos HM (1989) Personality structure disturbances and psychiatric manifestations in primary Sjögren’s syndrome. J Autoimmunity 2:489–493
Olsen ML, Arnett FC, Rosenbaum D, Grotta J, Warner NB (1989) Sjögren’s syndrome and other rheumatic disorders presenting to a neurology service. J Autoimmunity 2:477–483
Vitali C, Tavoni A, Neri R, Castrogiovanni P, Pasero G, Bombardieri S (1989) Fibromyalgia features in patients with Sjögren’s syndrome. Scand J Rheumatol 18:21–27
Buyon J, Winchester RJ, Slade SG, Arnett F, Copel J, Friedman D, Lockshin MD (1993) Identification of mothers at risk for congenital heart block and other neonatal lupus syndromes in their children. Comparison of enzyme-linked immunosorbent assay and immunoblot for measurement of anti-SS-A/Ro and anti-SS-B/La antibodies. Arthritis Rheum 36:1263–1273
Reed BR, Lee LA, Harmon C, Wolfe R, Wiggins J, Peebles C, Weston WL (1983) Autoantibodies to SSA/Ro in infants with congenital heart block. J Pediatr 103:889–891
Chan EKL, Hamel JC, Buyon JP, Tan EM (1991) Molecular definition and sequence motifs of the 52-kD component of human SSA/Ro autoantigen. J Clin Invest 87:68–76
Deutscher SL, Harley JB, Keene JD (1988) Molecular analysis of the 60-kDa human Ro ribonucleoprotein. Proc Natl Acad Sci USA 85:9479–9483
Kunogi Y (2003) Mesangial cell proliferation inhibitors for the treatment of proliferative glomerular disease. Med Res Rev 23:15–31
Doskocz R, Adamiec R (1999) Kwiatkowska. Endothelial response for the presence of chosen antinuclear antibodies, anti-Ro (SS-A) and anti-La (SS-B) and anti-Sm in vasculitis against the background of existing lupus erythematosus. Pol Arch Med Wewn 102:955–960
Acknowledgments
We express our thanks to Dr. Rie Akaho for her psychiatric observations.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Onoda, M., Inokuma, S. & Arai, S. Anti-SS-A (Ro) antibody is positively associated with steroid-induced psychiatric events in systemic lupus erythematosus patients. Rheumatol Int 33, 1437–1442 (2013). https://doi.org/10.1007/s00296-012-2557-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-012-2557-3