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Cerebrovascular events reported in 4.5% of patients with SLE, largely attributable to lupus
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Cerebrovascular events — particularly stroke and transient ischemia — are the fourth most common neuropsychiatric event in patients with systemic lupus erythematosus, and are typically attributable to the disease, according to findings published in Arthritis Care and Research.
The researchers also found that patients experienced a sustained drop in their health-related quality of life after a cerebrovascular event.
“Cerebrovascular events are reported in 5% to 18% of patients in previous cohort studies,” John G. Hanly, MD, of the Queen Elizabeth II Health Sciences Centre and Dalhousie University, in Halifax, Canada, and colleagues wrote. “Potential etiologies include procoagulant factors due to SLE (eg, antiphospholipid antibodies, endothelial activation and vasculitis) and factors which promote accelerated atherosclerosis (eg, hypertension, hyperlipidemia and SLE itself). The relative contribution of these factors and the outcome of clinical cerebrovascular events in a general lupus population have not been well documented.”
To describe the frequency, associations and outcomes of various cerebrovascular events in lupus, the researchers evaluated 1,826 patients with SLE annually for 19 neuropsychiatric events. The researchers focused on five cerebrovascular events — stroke, transient ischemia, chronic multifocal ischemia, subarachnoid/intercranial hemorrhage and sinus thrombosis.
Patients were evaluated for global disease activity, SLICC/ACR damage index and SF-36 scores. Statistical analysis included time-to-event, linear and logistic regression, and multi-state models. Among the patients, disease duration lasted a mean of 5.6 months, with follow-up analyses occurring over a mean of 6.6 years.
According to the researchers, cerebrovascular events were the fourth most common neuropsychiatric issue, with 4.5% of participants experiencing 109 events. Of those events, 94.5% were determined to be attributable to SLE, and 40.4% were identified at the time of patient enrollment. The most common cerebrovascular events were stroke, which accounted for 55% of the events, and transient ischemia, representing 25.7%.
Lupus anticoagulant antibodies increased the risk for initial stroke and sinus thrombosis (HR = 2.23; 95% CI, 1.11-4.45; P = .024) and transient ischemia (HR = 3.01; 95% CI, 1.15-7.9; P = .025), the researchers found. In addition, although most participants experienced disease improvement on physician assessment, patients reported a sustained reduction in SF-36 summary and subscale scores after the occurrence of cerebrovascular events (P < .0001).
“In our study, cerebrovascular events were ranked the fourth most common neuropsychiatric event, with a prevalence of 4.5%,” Hanly and colleagues wrote. “... As most of the events occurred early in the disease course, it is possible that cerebrovascular events occurring later in the disease may be more frequently attributed to atherosclerosis, but further follow-up is required to confirm this.” – by Jason Laday
Disclosure: Hanly reports grant support from the Canadian Institutes of Health Research. See the full study for additional researchers’ disclosures.
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