405 Structural neural underpinnings of low mood and anxiety in childhood onset systemic lupus erythematosus

ObjectivesEmotional dysfunction in childhood-onset systemic lupus erythematosus (cSLE) impacts clinical outcomes and quality of life, but the relationship to lupus brain inflammation is poorly understood. We aimed to investigate the structural neural metrics and disease activity measures that predict anxiety and depression in cSLE and non-cSLE children.MethodsA cross-sectional sample of patients with cSLE (meeting ACR and/or SLICC classification criteria for SLE) and healthy controls, aged 10-17 years completed self-reported measures of depression (Beck Depression Inventory-II/Children’s Depression Inventory-2) and anxiety (Screen for Child Anxiety Related Disorders). Elevated depression/anxiety symptoms were determined by established clinical cut-offs. T1-weighted sequences were acquired on a 3T Siemens MRI. MRI scans were spatially normalized using the MNI-152 template, and grey and white matter were segmented to estimate brain volume, surface area and cortical thickness in Freesurfer. Measures of disease duration, activity (SLE Disease Activity Index (SLEDAI) 2000), glucocorticoid use and inflammation were collected. Partial least squares (PLS) analyses were used to investigate the association between structural brain metrics and disease measures with depression/anxiety symptom severity.ResultsTwenty-seven patients with cSLE (mean age=15.4 years (SD 1.7) and median SLEDAI=2.0 (IQR 2-4)) and 14 healthy controls were recruited. There were no group differences in age, sex or ethnicity. Median cumulative glucocorticoid use in this sample was 3.2 grams prednisone-equivalent (IQR 0.7- 11.2). One cSLE patient had a history of neuropsychiatric lupus. We did not find group differences in prevalence of clinically elevated depression (cSLE= 12/27, controls=6/14) or anxiety (cSLE= 11/27, controls=7/14). Within group analysis of brain MRI showed that for both cSLE patients and controls, worse mood and anxiety were both predicted by reduced right anterior cingulate thickness. Within the cSLE group, worse mood and anxiety was predicted by higher cumulative steroid use, reduced right fusiform gyrus cortical thickness, and increased left amygdala and right parahippocampal volumes and thickness.ConclusionThis cross-sectional sample of cSLE patients had mild disease activity at the time of the study, and a high but similar prevalence of emotion problems compared to controls. Worse emotional functioning was associated with altered structural changes in regions known to und