A new study found that higher glucocorticoid (steroid) exposure and limited practical social support were associated with an increased risk of long-term neuropsychiatric damage in people with systemic lupus erythematosus (SLE). Neuropsychiatric complications of lupus can affect the brain and nervous system and lead to complications such as stroke, seizures, nerve damage, cognitive impairment and psychosis. The study found that access to practical support (i.e., transportation, financial assistance and help with daily activities) was among the strongest social factors associated with neuropsychiatric damage, highlighting the potential role of both medical and social factors in lupus outcomes. 

The study analyzed data from 657 people with SLE participating in the multiethnic Lupus in Minorities: Nature vs. Nurture (LUMINA) study. Using a machine learning model, researchers evaluated 173 clinical, treatment and social factors to identify those most strongly associated with long-term neuropsychiatric damage. Higher glucocorticoid exposure was the strongest predictor of irreversible neurologic damage, while limited tangible social support was also strongly associated with increased risk. The impact of poor social support seemed to be independent of a person’s lupus severity. The study also found that different factors were associated with cognitive symptoms than with structural neurologic damage, suggesting these complications may develop through different pathways. 

These findings suggest that reducing long-term glucocorticoid exposure when possible and addressing social support needs may help inform future approaches to lupus care. More research is needed to validate these findings before they can be applied in clinical practice. Learn more about lupus and the nervous system.  

Read the study