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Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study
John G Hanly1, Qiuju Li2, Li Su2
1Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Arthritis Care & Research
|January 10, 2018
Summary
Cerebrovascular events (CerVEs) are common in systemic lupus erythematosus (SLE), often linked to lupus activity and African ancestry. While physicians report good outcomes, patients experience lasting reductions in quality of life after a CerVE.
Area of Science:
- Neurology
- Rheumatology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
- Neuropsychiatric (NP) events are common in SLE, impacting patient morbidity and mortality.
- Cerebrovascular events (CerVEs) represent a significant subset of NP manifestations in SLE.
Purpose of the Study:
- To investigate the incidence, characteristics, and outcomes of cerebrovascular events (CerVEs) in a multiethnic/racial inception cohort of SLE patients.
- To identify clinical and autoantibody associations with CerVEs in SLE.
- To evaluate the impact of CerVEs on patient-reported quality of life.
Main Methods:
- Annual assessment of 1,826 SLE patients for 19 NP events, including 5 types of CerVEs.
- Collection of data on disease activity (SLEDAI 2000), damage (SLICC/ACR DI), and quality of life (SF-36).
- Utilized time-to-event analysis, linear/logistic regression, and multistate models.
Main Results:
- CerVEs were the fourth most frequent NP event, occurring in 82 patients (109 events), predominantly stroke and transient ischemia.
- CerVEs were associated with SLE activity, other NP events, African ancestry, and increased organ damage.
- Lupus anticoagulant was linked to increased risk of stroke, sinus thrombosis, and transient ischemic attack.
Conclusions:
- Cerebrovascular events are a significant NP manifestation in SLE, often attributable to lupus.
- Physician-reported outcomes for CerVEs are generally favorable, showing resolution or improvement.
- Patients consistently report a sustained decrease in health-related quality of life following a CerVE, highlighting a discrepancy in outcome assessment.
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