Retinal Vasculitis and Stroke Risk in Patients with Systemic Lupus Erythematosus

To assess the association between retinal vasculitis and cerebral stroke and mortality in patients with systemic lupus erythematosus (SLE).

Patients with SLE with and without retinal vasculitis were identified in the TriNetX research network. Initially, there were 337,411 patients with SLE and no retinal vasculitis and 570 patients with SLE and retinal vasculitis. After matching to balance age, sex, race, and cardiac risk factors, 540 patients remained in each group. Outcomes evaluated included stroke risk and mortality over a 20-year follow-up. Statistical analysis included risk ratios (RR), Kaplan-Meieranalysis, and Cox proportional hazards modeling.

The 1-year stroke risk was 1.9% in patients without retinal vasculitis and 4.5% with retinal vasculitis. At 5 years, risks were 4.7% and 9.1%; at 10 years, 5.6% and 13.2%; and at 20 years, 7.5% and 17.1%, respectively (p < 0.001). The average weighted stroke risk in patients with and without retinal vasculitis was 8.3% and 3.8%, respectively (RR: 2.19, 95% CI: 1.31-3.68, p = 0.002). Cox regression analysis of stroke risk showed a hazard ratio for retinal vasculitis of 2.25 (95% CI: 1.72-2.94, p < 0.001). Mortality rates over 20 years were 6.9% without retinal vasculitis and 8.3% with retinal vasculitis (RR: 1.21, 95% CI: 0.8 - 1.84, p = 0.3626).

The presence of retinal vasculitis in patients with SLE significantly increases the risk of stroke over a 20-year period, highlighting the importance of early identification and timely referral of this group of patients.