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Arthritis Care Res (Hoboken). 2018 Oct;70(10):1478-1487. doi: 10.1002/acr.23509. Epub 2018 Sep 1.

Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study.

Author information

1
Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
2
MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
3
Toronto Western Hospital and University of Toronto, Ontario, Canada.
4
University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK.
5
Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
6
Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
7
McGill University, Montreal, Quebec, Canada.
8
University of Calgary, Alberta, Canada.
9
Cedars-Sinai Medical Center and University of California at Los Angeles, David Geffen School of Medicine, Los Angeles.
10
University College London, London, UK.
11
Oklahoma Medical Research Foundation, Oklahoma City.
12
Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada.
13
Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK, and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
14
Johns Hopkins University School of Medicine, Baltimore, Maryland.
15
State University of New York Downstate Medical Center, Brooklyn.
16
University of North Carolina, Chapel Hill.
17
Landspitali University Hospital, Reykjavik, Iceland.
18
Northwestern University and Feinberg School of Medicine, Chicago, Illinois.
19
Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, Scotland UK.
20
Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania.
21
Lund University, Lund, Sweden.
22
Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, UK.
23
University of Alabama at Birmingham, Birmingham.
24
Karolinska Institute, Stockholm, Sweden.
25
Feinstein Institute for Medical Research, Manhasset, New York.
26
Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain.
27
Institut d'Investigacions Biomèdiques August Pi I Sunyer, IDIBAPS, Hospital Clínic, Barcelona, Spain.
28
Emory University, Atlanta, Georgia.
29
Istanbul University, Istanbul, Turkey.
30
University of California at San Diego, La Jolla.
31
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
32
University of Manitoba, Winnipeg, Manitoba, Canada.
33
Medical University of South Carolina, Charleston.
34
New York University, New York, New York.

Abstract

OBJECTIVE:

To determine the frequency, characteristics, and outcomes of cerebrovascular events (CerVEs), as well as clinical and autoantibody associations in a multiethnic/racial inception cohort of patients with systemic lupus erythematosus (SLE).

METHODS:

A total of 1,826 patients were assessed annually for 19 neuropsychiatric (NP) events, including 5 types of CerVEs: 1) stroke, 2) transient ischemia, 3) chronic multifocal ischemia, 4) subarachnoid/intracranial hemorrhage, and 5) sinus thrombosis. Global disease activity (Systemic Lupus Erythematosus Disease [SLE] Activity Index 2000), damage scores (SLE International Collaborating Clinics/American College of Rheumatology Damage Index), and Short Form 36 (SF-36) scores were collected. Time to event, linear and logistic regressions, and multistate models were used as appropriate.

RESULTS:

CerVEs were the fourth most frequent NP event: 82 of 1,826 patients had 109 events; of these events, 103 were attributed to SLE, and 44 were identified at the time of enrollment. The predominant events were stroke (60 of 109 patients) and transient ischemia (28 of 109 patients). CerVEs were associated with other NP events attributed to SLE, non-SLE-attributed NP events, African ancestry (at US SLICC sites), and increased organ damage scores. Lupus anticoagulant increased the risk of first stroke and sinus thrombosis and transient ischemic attack. Physician assessment indicated resolution or improvement in the majority of patients, but patients reported sustained reduction in SF-36 summary and subscale scores following a CerVE.

CONCLUSION:

CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician-reported outcomes, patients reported a sustained reduction in health-related quality of life following a CerVE.

PMID:
29316357
PMCID:
PMC6033693
[Available on 2019-10-01]
DOI:
10.1002/acr.23509

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