Headache in Systemic Lupus Erythematosus Results From a Prospective, International Inception Cohort Studyopen access
- Authors
- Hanly, John G.; Urowitz, Murray B.; O'Keeffe, Aidan G.; Gordon, Caroline; Bae, Sang-Cheol; Sanchez-Guerrero, Jorge; Romero-Diaz, Juanita; Clarke, Ann E.; Bernatsky, Sasha; Wallace, Daniel J.; Ginzler, Ellen M.; Isenberg, David A.; Rahman, Anisur; Merrill, Joan T.; Petri, Michelle; Fortin, Paul R.; Gladman, Dafna D.; Fessler, Barri J.; Alarcon, Graciela S.; Bruce, Ian N.; Dooley, Mary Anne; Steinsson, Kristjan; Khamashta, Munther A.; Ramsey-Goldman, Rosalind; Manzi, Susan; Sturfelt, Gunnar K.; Nived, Ola; Zoma, Asad A.; van Vollenhoven, Ronald F.; Ramos-Casals, Manuel; Aranow, Cynthia; Mackay, Meggan; Ruiz-Irastorza, Guillermo; Kalunian, Kenneth C.; Lim, S. Sam; Inanc, Murat; Kamen, Diane L.; Peschken, Christine A.; Jacobsen, Soren; Theriault, Chris; Thompson, Kara; Farewell, Vernon
- Issue Date
- Nov-2013
- Publisher
- WILEY
- Citation
- ARTHRITIS AND RHEUMATISM, v.65, no.11, pp.2887 - 2897
- Indexed
- SCIE
SCOPUS
- Journal Title
- ARTHRITIS AND RHEUMATISM
- Volume
- 65
- Number
- 11
- Start Page
- 2887
- End Page
- 2897
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/26612
- DOI
- 10.1002/art.38106
- ISSN
- 0004-3591
- Abstract
- 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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