SLE Linked to Higher Cerebrovascular Risk

Cerebrovascular events such as stroke and transient ischemia are often attributable to systemic lupus erythematosus (SLE) in patients with the condition, and are associated with sustained reduction in health-related quality of life, according to a recent study.

For their study, the researchers evaluated 1826 patients with SLE. Mean age was 35.1 years, and 88.8% of patients were female. Follow-up lasted a mean of 6.6 years. Each patient was evaluated on a yearly basis for 19 neuropsychiatric events, including various cerebrovascular events (stroke, transient ischemia, chronic multifocal ischemia, subarachnoid/intracranial hemorrhage, and sinus thrombosis).
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Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 scores were recorded, and various models were used as appropriate.

Findings revealed that cerebrovascular events occurred frequently among these patients, serving as the fourth most frequent neuropsychiatric event of all 19 that were assessed. A total of 82 (4.5%) patients experienced 109 events, of which 103 (94.5%) were associated with SLE and 44 (40.4%) were identified at enrollment. The most commonly occurring cerebrovascular events were stroke (n=60) and transient ischemia (n=28).

The researchers noted that cerebrovascular events were associated with other neuropsychiatric events attributed to SLE (hazard ratio [HR] 3.16), non-SLE neuropsychiatric events (HR 2.60), African ancestry at US Systemic Lupus International Collaborating Clinics (SLICC) sites (HR 2.04), and organ damage.

The risk of first stroke and sinus thrombosis (HR 2.23) and TIA (HR 3.01) were associated with lupus anticoagulant use. The researchers also found that, upon physician assessment, resolution or improvement had occurred in the majority of patients, and patients reported sustained reduction in SF-36 summary and subscale scores after cerebrovascular events.

“[Cerebrovascular events], the fourth most frequent [neuropsychiatric] event in SLE, are usually attributable to lupus,” the researchers concluded. “In contrast to good physician reported outcomes, patients report a sustained reduction in health-related quality of life following [cerebrovascular events].”

—Christina Vogt

Reference:

Hanly JG, Li Q, Su L, et al. Cerebrovascular events in systemic lupus erythematosus [Published online January 5, 2018]. Arthritis Care Res. doi:10.1002/acr.23509.