Fatigue and cognitive function in systemic lupus erythematosus

associations with white matter microstructural damage. A diffusion tensor MRI study and meta-analysis

S. J. Wiseman, M. E. Bastin, I. F. Hamilton, D. Hunt, S. J. Ritchie, E. N. Amft, S. Thomson, J. F. F. Belch, S. H. Ralston, J. M. Wardlaw (Lead / Corresponding author)

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: The objective of this study was to investigate fatigue and cognitive impairments in systemic lupus erythematous (SLE) in relation to diffuse white matter microstructural brain damage.

METHODS: Diffusion tensor MRI, used to generate biomarkers of brain white matter microstructural integrity, was obtained in patients with SLE and age-matched controls. Fatigue and cognitive function were assessed and related to SLE activity, clinical data and plasma biomarkers of inflammation and endothelial dysfunction.

RESULTS: Fifty-one patients with SLE (mean age 48.8 ± 14.3 years) were included. Mean diffusivity (MD) was significantly higher in all white matter fibre tracts in SLE patients versus age-matched healthy controls (p < 0.0001). Fatigue in SLE was higher than a normal reference range (p < 0.0001) and associated with lower MD (ß = -0.61, p = 0.02), depression (ß = 0.17, p = 0.001), anxiety (ß = 0.13, p = 0.006) and higher body mass index (ß = 0.10, p = 0.004) in adjusted analyses. Poorer cognitive function was associated with longer SLE disease duration (p = 0.003) and higher MD (p = 0.03) and, in adjusted analysis, higher levels of IL-6 (ß = -0.15, p = 0.02) but not with MD. Meta-analysis (10 studies, n = 261, including the present study) confirmed that patients with SLE have higher MD than controls.

CONCLUSION: Patients with SLE have more microstructural brain white matter damage for age than the general population, but this does not explain increased fatigue or lower cognition in SLE. The association between raised IL-6 and worse current cognitive function in SLE should be explored in larger datasets.

Original languageEnglish
Pages (from-to)588-597
Number of pages10
JournalLupus
Volume26
Issue number6
Early online date29 Sep 2016
DOIs
Publication statusPublished - 1 May 2017

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Diffusion Magnetic Resonance Imaging
Systemic Lupus Erythematosus
Cognition
Fatigue
Meta-Analysis
Interleukin-6
Brain
Reference Values
Biomarkers
Body Mass Index
Anxiety
White Matter
Depression
Inflammation
Population

Keywords

  • Autoimmune diseases
  • Cytokines
  • Inflammation
  • Systemic lupus
  • Erythematosus

Cite this

Wiseman, S. J. ; Bastin, M. E. ; Hamilton, I. F. ; Hunt, D. ; Ritchie, S. J. ; Amft, E. N. ; Thomson, S. ; Belch, J. F. F. ; Ralston, S. H. ; Wardlaw, J. M. / Fatigue and cognitive function in systemic lupus erythematosus : associations with white matter microstructural damage. A diffusion tensor MRI study and meta-analysis. In: Lupus. 2017 ; Vol. 26, No. 6. pp. 588-597.
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abstract = "OBJECTIVE: The objective of this study was to investigate fatigue and cognitive impairments in systemic lupus erythematous (SLE) in relation to diffuse white matter microstructural brain damage.METHODS: Diffusion tensor MRI, used to generate biomarkers of brain white matter microstructural integrity, was obtained in patients with SLE and age-matched controls. Fatigue and cognitive function were assessed and related to SLE activity, clinical data and plasma biomarkers of inflammation and endothelial dysfunction.RESULTS: Fifty-one patients with SLE (mean age 48.8 ± 14.3 years) were included. Mean diffusivity (MD) was significantly higher in all white matter fibre tracts in SLE patients versus age-matched healthy controls (p < 0.0001). Fatigue in SLE was higher than a normal reference range (p < 0.0001) and associated with lower MD ({\ss} = -0.61, p = 0.02), depression ({\ss} = 0.17, p = 0.001), anxiety ({\ss} = 0.13, p = 0.006) and higher body mass index ({\ss} = 0.10, p = 0.004) in adjusted analyses. Poorer cognitive function was associated with longer SLE disease duration (p = 0.003) and higher MD (p = 0.03) and, in adjusted analysis, higher levels of IL-6 ({\ss} = -0.15, p = 0.02) but not with MD. Meta-analysis (10 studies, n = 261, including the present study) confirmed that patients with SLE have higher MD than controls.CONCLUSION: Patients with SLE have more microstructural brain white matter damage for age than the general population, but this does not explain increased fatigue or lower cognition in SLE. The association between raised IL-6 and worse current cognitive function in SLE should be explored in larger datasets.",
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Wiseman, SJ, Bastin, ME, Hamilton, IF, Hunt, D, Ritchie, SJ, Amft, EN, Thomson, S, Belch, JFF, Ralston, SH & Wardlaw, JM 2017, 'Fatigue and cognitive function in systemic lupus erythematosus: associations with white matter microstructural damage. A diffusion tensor MRI study and meta-analysis', Lupus, vol. 26, no. 6, pp. 588-597. https://doi.org/10.1177/0961203316668417

Fatigue and cognitive function in systemic lupus erythematosus : associations with white matter microstructural damage. A diffusion tensor MRI study and meta-analysis. / Wiseman, S. J.; Bastin, M. E.; Hamilton, I. F.; Hunt, D.; Ritchie, S. J.; Amft, E. N.; Thomson, S.; Belch, J. F. F.; Ralston, S. H.; Wardlaw, J. M. (Lead / Corresponding author).

In: Lupus, Vol. 26, No. 6, 01.05.2017, p. 588-597.

Research output: Contribution to journalArticle

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T1 - Fatigue and cognitive function in systemic lupus erythematosus

T2 - associations with white matter microstructural damage. A diffusion tensor MRI study and meta-analysis

AU - Wiseman, S. J.

AU - Bastin, M. E.

AU - Hamilton, I. F.

AU - Hunt, D.

AU - Ritchie, S. J.

AU - Amft, E. N.

AU - Thomson, S.

AU - Belch, J. F. F.

AU - Ralston, S. H.

AU - Wardlaw, J. M.

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Y1 - 2017/5/1

N2 - OBJECTIVE: The objective of this study was to investigate fatigue and cognitive impairments in systemic lupus erythematous (SLE) in relation to diffuse white matter microstructural brain damage.METHODS: Diffusion tensor MRI, used to generate biomarkers of brain white matter microstructural integrity, was obtained in patients with SLE and age-matched controls. Fatigue and cognitive function were assessed and related to SLE activity, clinical data and plasma biomarkers of inflammation and endothelial dysfunction.RESULTS: Fifty-one patients with SLE (mean age 48.8 ± 14.3 years) were included. Mean diffusivity (MD) was significantly higher in all white matter fibre tracts in SLE patients versus age-matched healthy controls (p < 0.0001). Fatigue in SLE was higher than a normal reference range (p < 0.0001) and associated with lower MD (ß = -0.61, p = 0.02), depression (ß = 0.17, p = 0.001), anxiety (ß = 0.13, p = 0.006) and higher body mass index (ß = 0.10, p = 0.004) in adjusted analyses. Poorer cognitive function was associated with longer SLE disease duration (p = 0.003) and higher MD (p = 0.03) and, in adjusted analysis, higher levels of IL-6 (ß = -0.15, p = 0.02) but not with MD. Meta-analysis (10 studies, n = 261, including the present study) confirmed that patients with SLE have higher MD than controls.CONCLUSION: Patients with SLE have more microstructural brain white matter damage for age than the general population, but this does not explain increased fatigue or lower cognition in SLE. The association between raised IL-6 and worse current cognitive function in SLE should be explored in larger datasets.

AB - OBJECTIVE: The objective of this study was to investigate fatigue and cognitive impairments in systemic lupus erythematous (SLE) in relation to diffuse white matter microstructural brain damage.METHODS: Diffusion tensor MRI, used to generate biomarkers of brain white matter microstructural integrity, was obtained in patients with SLE and age-matched controls. Fatigue and cognitive function were assessed and related to SLE activity, clinical data and plasma biomarkers of inflammation and endothelial dysfunction.RESULTS: Fifty-one patients with SLE (mean age 48.8 ± 14.3 years) were included. Mean diffusivity (MD) was significantly higher in all white matter fibre tracts in SLE patients versus age-matched healthy controls (p < 0.0001). Fatigue in SLE was higher than a normal reference range (p < 0.0001) and associated with lower MD (ß = -0.61, p = 0.02), depression (ß = 0.17, p = 0.001), anxiety (ß = 0.13, p = 0.006) and higher body mass index (ß = 0.10, p = 0.004) in adjusted analyses. Poorer cognitive function was associated with longer SLE disease duration (p = 0.003) and higher MD (p = 0.03) and, in adjusted analysis, higher levels of IL-6 (ß = -0.15, p = 0.02) but not with MD. Meta-analysis (10 studies, n = 261, including the present study) confirmed that patients with SLE have higher MD than controls.CONCLUSION: Patients with SLE have more microstructural brain white matter damage for age than the general population, but this does not explain increased fatigue or lower cognition in SLE. The association between raised IL-6 and worse current cognitive function in SLE should be explored in larger datasets.

KW - Autoimmune diseases

KW - Cytokines

KW - Inflammation

KW - Systemic lupus

KW - Erythematosus

U2 - 10.1177/0961203316668417

DO - 10.1177/0961203316668417

M3 - Article

VL - 26

SP - 588

EP - 597

JO - Lupus

JF - Lupus

SN - 0961-2033

IS - 6

ER -