Psychiatric disorders often preceded a diagnosis of systemic lupus erythematosus (SLE) in young people, and were strongly associated with heavy use of healthcare services in the prediagnosis year for nonpsychiatric problems suggestive of underlying SLE, researchers reported.
Compared with matched healthy controls, youth with SLE had significantly more hospital visits in the year before diagnosis across all clinical settings, according to Joyce C. Chang, MD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues:
- Ambulatory: incidence rate ratio 2.48 (P<0.001)
- Emergency department (ED): IRR 3.42 (P<0.001)
- Inpatient: IRR 3.02 (P<0.001)
Chang's group noted that autoantibodies and clinical symptoms can precede SLE diagnosis by years, but not enough to allow definitive diagnosis early in the disease course. They said exploring patterns of prediagnosis healthcare use is a first step in characterizing the path from symptom onset to diagnosis, and may provide insight into strategies to expedite SLE diagnosis and treatment.
"Examining variable diagnostic trajectories of youth presenting for acute care preceding SLE diagnosis, and increased attention to psychiatric morbidity may help improve care for youth with new-onset SLE," they wrote.