Neurological and psychiatric manifestations affect most lupus individuals and include depression, anxiety, mood disorders, and cognitive dysfunction. Although there is evidence supporting suboptimal decision-making in lupus and its association with glucocorticoids consumption, it is not clear what variables impact such decisions. The aim of this study is to explore how social, clinical, psychological, and demographic factors impact social and temporal decision-making in people with lupus. Through a within-subjects experimental-design, our participants responded to social, clinical, psychological, and demographic electronic questionnaires. Then, they participated in two behavioral economics experiments: the third-party dictator game, and the delay discounting task. Our results show that hostility, and age are essential predictors of social decisions, whereas obsessive-compulsiveness and anxiety better predict temporal decisions. These variables behave as expected, but anxiety shows unexpected results: most anxious people act patiently and prefer delayed but bigger rewards. Finally, clinical factors are critical decision predictors for social and temporal decisions. When people are in remission, they tend to impose higher punishment on those who violate the social norm, and they also tend to prefer immediate rewards. When taking glucocorticoids, they also prefer immediate rewards, and as the dosage of glucocorticoids intake increases, they tend to impose higher punishment on norm violators. Clinicians, researchers, and practitioners must consider the side effects of glucocorticoids on decision-making.

The authors have declared no competing interest.

This project was supported by CONACYT-FORDECYT-PRONACES grants no. [11311] and [6390]. A.M.R. was supported by Programa de Apoyo a Proyectos de Investigacion e Innovacion Tecnologica,Universidad Nacional Autonoma de Mexico (PAPIIT-UNAM) grants no. IA203021 and IN218023. A.L.H.L. is a doctoral student from Programa de Doctorado en Ciencias Biomedicas, Universidad Nacional Autonoma de Mexico (UNAM) and she received fellowship CVU/Becario (711015/790972) from Consejo Nacional de Humanidades, Ciencia y Tecnologia (CONAHCYT). D.M. is a posdoctoral researcher supported by Consejo Nacional de Humanidades Ciencia y Tecnologia (CONAHCYT), Estancias Posdoctorales por Mexico Convocatoria 2023(1), CVU 371892. L.M.P.M is an senior undergraduate student in Neurociencias, Universidad Nacional Autonoma de Mexico (UNAM) funded by Programa de Apoyo a Proyectos de Investigacion e Innovacion Tecnologica (PAPIIT) with project code IN218023. He also receives a grant to continue the project abroad, financed by the Programa para el Impulso a la Titulacion por Actividades Academicas en el Extranjero (PITAAE).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee/IRB of Neurobiology Institute at the National Autonomous University of Mexico (protocol 093) gave ethical approval for this work

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes