Cerebrovascular dysfunction in rheumatic diseases: Mechanisms, clinical manifestations, and therapeutic implications

Rheumatic diseases, traditionally recognized for their joint and systemic inflammatory manifestations, increasingly reveal profound impacts on cerebrovascular integrity and neurovascular homeostasis. Patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS), psoriatic arthritis (PsA), and related disorders exhibit heightened risks of stroke, cognitive impairment, and neuropsychiatric syndromes, underscoring the critical interplay between systemic autoimmunity and cerebrovascular health. This review synthesizes evidence on the mechanisms driving cerebral vasculature dysfunction in these conditions, emphasizing endothelial injury, microvascular pathology, and neuroimmune crosstalk. We further delineate disease-specific manifestations, imaging findings, and therapeutic strategies, while identifying current research gaps in subclinical neurovascular assessment and targeted therapy.