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New research · Rheumatology
Lupus science & medicine · 22h
Cohort studyLupus science & medicine · 2026

Glucocorticoid exposure and social support deficits as longitudinal predictors of long-term neuropsychiatric damage in SLE: insights from the LUMINA cohort (LXXXIII).

Mario Felix, Gerald McGwin, Graciela S Alarcon … Evelyn Hsieh
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RheumatologyCohort study

Glucocorticoid dose contributes more to all neuropsychiatric damage risk.

Glucocorticoid exposure and social support deficits as longitudinal predictors of long-term neuropsychiatric damage in SLE: insights from the LUMINA cohort (LXXXIII).

Mario Felix et al. · Lupus science & medicine · 2026
Purpose

To identify longitudinal predictors of neuropsychiatric damage in SLE and compare predictors of organic versus all neuropsychiatric outcomes.

Methods

We studied 657 patients from the multiethnic Lupus in Minorities: Nature vs Nurture cohort (5944 person-visit observations).

n = 657 patients
2.8-fold
Results
Current glucocorticoid dose contributes 2.8-fold more to all neuropsychiatric damage risk.
n = 657 patients
More results

92 patients (14.0%) had organic and 197 (30.0%) had any neuropsychiatric damage; models were trained on incident events (48 and 90, respectively).

Random survival forests achieved C-indices of 0.738 (organic) and 0.775 (all neuropsychiatric damage) outperforming Cox regression.

More results

Tangible material support deficits specifically dominated the social support signal.

For the secondary outcome, physician global assessment, fatigue and pain ranked highest, suggesting distinct predictor profiles for cognitive versus organic outcomes.

“
Conclusion · 1 of 2

In this exploratory analysis, glucocorticoid exposure and tangible social support deficits emerged as leading, potentially modifiable predictors of neuropsychiatric damage in SLE, often outranking disease activity measures, with implications for glucocorticoid stewardship, tangible-support screening and outcome-specific management.

Conclusion · 2 of 2

External validation in an independent contemporary cohort is required prior to clinical translation.

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