The interplay between tumor necrosis factor alpha, disease activity, and depressive symptoms among Egyptian female patients with systemic lupus erythematosus

Abstract

One of the most remarkable presentations of systemic lupus erythematosus (SLE) is depression. Our aim was to elucidate the potential relationship between disease activity, depressive symptoms, and tumor necrosis factor alpha (TNF-α) in patients with SLE. Sixty female patients with SLE and thirty comparable healthy controls were recruited. According to systemic lupus erythematosus disease activity index, patients were subdivided into two similar groups; active and inactive. Complete clinical and laboratory assessments were done to authenticate the diagnosis of SLE and outline its activity. All participants were assessed using the Beck depression Inventory (BDI) to diagnose and determine the severity of depressive symptoms. TNF-α level was assessed using Enzyme linked immunosorbent assay technique. Using BDI, patients with SLE activity showed higher prevalence of depression 19 (63.3%) compared to those with inactive SLE and control groups (P < 0.001). TNF-α level was markedly elevated amongst patients with active SLE in comparison to inactive and control groups (P <0.001). TNF-α differentiated SLE patients into with and without depression at cut-off value (>360 ng/l) (AUC = 0.726; P=0.0008; 95% CI 1.3-2.7). Multivariable regression analysis for prediction of depression revealed that TNF-α was the only independent predictor of depression (P= 0.011). In conclusion, patients with increased SLE activity are more prone to depression especially, moderate to severe degree. TNF-α level could be of significance in predilection of depression and SLE activity in patients with SLE. Hence, future studies are essential to test the treatment modalities targeting TNF-α in those patients.