Anxiety may be linked to C3 and C4 levels in patients with systemic lupus erythematosus

1. In this cross-sectional study, there was a significant negative correlation between anxiety scores and C3 levels in patients with systemic lupus erythematosus (SLE), and a weak correlation between anxiety and C4 levels.

2. However, there was no statistically significant association between depressive symptoms and C3 or C4 levels.

Evidence Rating Level: 3 (Average)

Anxiety and depression are common mental illnesses that are often comorbid with chronic health conditions. Systemic lupus erythematosus (SLE) is an autoimmune condition that is characterized by chronic inflammation. Although depression and anxiety have been linked to SLE and other inflammatory conditions, the underlying cause of this association is unclear. Some have suggested that pro-inflammatory mediators, such as complement activation, such as C3 and C4, and hypothalamic-pituitary-adrenal axis dysfunction may be the underlying mechanism. The present study aimed to evaluate the relationship between SLE disease activity, C3 and C4 levels, and depression and anxiety in SLE patients.

This cross-sectional study included 120 SLE patients aged 18-60 from Cipto Mangunkusumo National Hospital in Indonesia. Participants were excluded if they had an acute infection that lasted more than a week, a chronic infection, such as HIV or pulmonary tuberculosis, steroid consumption greater than 40 mg prednisolone equivalent per day, or a history of neuropsychiatric SLE, psychopharmacology administration, or severe disease. The Hospital Anxiety and Depression Scale (HADS) was used to assess the degree of anxiety and depression, while the Mexican SLE Systemic Disease Activity (MEX SLEDAI) was used to assess SLE severity. C3 and C4 and other blood parameters were assessed via blood tests. The primary outcome was the association between MEX SLEDAI and HADS scores and complement levels.

The results demonstrated that there was a significant negative correlation between anxiety scores and C3 levels in SLE patients. There was also a correlation between anxiety and C4 levels, but this association was weak. There were no statistically significant associations between depressive symptoms and C3 or C4 levels or between anxiety or depressive symptoms and SLE disease activity. However, the study was limited by its cross-sectional nature, which limited its ability to determine causality or investigate long-term effects. Nonetheless, the study demonstrated a potential link between anxiety complement levels in patients with SLE.

Click to read the study in BMC Psychiatry

Image: PD

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