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Daily Psychosocial Stressors Interfere With the Dynamics of Urine Neopterin in a Patient With Systemic Lupus Erythematosus: An Integrative Single-Case Study

From the Departments of Medical Psychology and Psychotherapy (C.S., A.L., G.R., E.C., G.S.) and Internal Medicine (P.K.), University Hospital Innsbruck, and Institute of Medical Chemistry and Biochemistry (D.F.), University Innsbruck, Innsbruck, Austria.

View larger version (13K): [in a new window]   Fig. 1. Major life events and chronic difficulties during the 2 years preceding the study and their temporal relationship to the patient’s last flare-up in September 1995. Events and difficulties are indicated by serially numbered capital letters (E1 = patient’s orthopedic surgery, E2 = uncle’s operation, E3 = sister’s divorce, E4 = son leaves home, D1 = patient’s depression, D2 = patient’s chronic low back pain, D3 = patient’s court case for disability pension, D4 = family’s financial problems, D5 = nephew’s chronic cough). Additionally, they are characterized by time of occurrence (dotted line) and severity ratings. For example, the patient’s orthopedic surgery (E1) occurred in April 1995 and was rated as moderate (2) on short-term contextual threat and little (4) on long-term contextual threat. Another example is the patient’s depression (D1), which began with a "high moderate" contextual threat (3) in January 1995, did not change in severity, and ended in February 1995 after 4 to 5 weeks.

View larger version (23K): [in a new window]   Fig. 2. Urine neopterin time-series covering a period of 63 days. Both the raw neopterin data (black line) as well as the fit from the ARIMA model representing the series’ internal structure (gray line) are plotted. The 300-µmol urine neopterin level, which has been determined to be a significant predictor of SLE activity, is indicated by the dotted line. The data represent the mean of three independent determinations.

View larger version (28K): [in a new window]   Fig. 3. Residuals free of serial dependencies from both the urine neopterin model and the stress model. Both residuals from the neopterin model (gray line) and residuals from the stress model (black line) are plotted. Stress peaks are labeled according to the day on which the moderate incident occurred. Those associated with an increase in neopterin 1 day later are indicated in bold.