Dr. Hanly has received consulting fees, speaking fees, and/or honoraria from GlaxoSmithKline (less than $10,000).
Systemic Lupus Erythematosus
Headache in Systemic Lupus Erythematosus: Results From a Prospective, International Inception Cohort Study†
Article first published online: 28 OCT 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 65, Issue 11, pages 2887–2897, November 2013
How to Cite
Hanly, J. G., Urowitz, M. B., O'Keeffe, A. G., Gordon, C., Bae, S.-C., Sanchez-Guerrero, J., Romero-Diaz, J., Clarke, A. E., Bernatsky, S., Wallace, D. J., Ginzler, E. M., Isenberg, D. A., Rahman, A., Merrill, J. T., Petri, M., Fortin, P. R., Gladman, D. D., Fessler, B. J., Alarcón, G. S., Bruce, I. N., Dooley, M. A., Steinsson, K., Khamashta, M. A., Ramsey-Goldman, R., Manzi, S., Sturfelt, G. K., Nived, O., Zoma, A. A., van Vollenhoven, R. F., Ramos-Casals, M., Aranow, C., Mackay, M., Ruiz-Irastorza, G., Kalunian, K. C., Lim, S. S., Inanc, M., Kamen, D. L., Peschken, C. A., Jacobsen, S., Theriault, C., Thompson, K. and Farewell, V. (2013), Headache in Systemic Lupus Erythematosus: Results From a Prospective, International Inception Cohort Study. Arthritis & Rheumatism, 65: 2887–2897. doi: 10.1002/art.38106
The views expressed herein are those of the authors and are not necessarily those of the NHS, the NIHR, or the Department of Health, UK.
- Issue published online: 28 OCT 2013
- Article first published online: 28 OCT 2013
- Manuscript Accepted: 23 JUL 2013
- Manuscript Received: 1 MAR 2013
- Canadian Institutes of Health Research. Grant Number: MOP-86526
- Medical Research Council, UK. Grant Number: U105261167
- Lupus UK
- NIHR/Wellcome Trust Clinical Research Facility
- Ministry for Health and Welfare, Republic of Korea. Grant Number: Korea Healthcare Technology R&D project A120404
- National Scholar award from the Fonds de la Recherché en Santé de Quebec
- Distinguished Senior Investigator award from The Arthritis Society; he presently holds a Tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval
- Arthritis Research UK
- NIHR (Biomedical Research Unit funding)
- NIHR Manchester Biomedical Research Centre
- NIHR/Wellcome Trust Clinical Research Facility at Central Manchester Foundation Trust
- NIH. Grant Numbers: RR-00046, UL-1RR-025741, K24-AR-02318, P60-AR-48098, AR-43727
- Department of Education
- Research of the Basque Government
- Danish Rheumatism Association. Grant Number: A1028
- Novo Nordisk Foundation. Grant Number: A05990
- Singer Family Fund for Lupus Research
Errata: Incorrect Values for Intractable and Cluster Headaches at Enrollment Shown in Figure 1 and Incorrect Prevalence of Headache at Ten Years in Text of the Article by Hanly et al (Arthritis Rheum, November 2013)
Vol. 66, Issue 6, 1671, Article first published online: 27 MAY 2014
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).
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.
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.
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.