Background and aims To determine the frequency, associations and outcomes of cerebrovascular events (CerVEs) in a multi-ethnic/racial, prospective, inception cohort of SLE patients.
Methods Patients were assessed annually for 19 neuropsychiatric events including 5 types of CerVEs: (i) Stroke; (ii) Transient ischemia; (iii) Chronic multifocal ischemia; (iv) Subarachnoid and intracranial haemorrhage; (v) Sinus thrombosis. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 subscale, mental (MCS) and physical (PCS) component summary scores were collected. Time to event, linear and logistic regressions and multi-state models were used as appropriate.
Results Of 1826 SLE patients, 88.8% were female, 48.8% Caucasian, mean±SD age 35.1±13.3 years, disease duration 5.6±4.2 months and follow-up 6.6±4.1 years. CerVEs were the fourth most frequent NP event: 82/1,826 (4.5%) patients had 109 events and 103/109 (94.5%) were attributed to SLE. The predominant events were stroke [60/109 (55.0%)] and transient ischemia [28/109 (25.7%)]. CerVEs were associated with NP events attributed to SLE (HR (95% CI): (3.16; 1.73–5.75), non-SLE (2.60; 1.49–4.51) (p<0.001), African ancestry at US SLICC sites (2.04; 1.01–4.13) (p=0.047) and organ damage (p=0.041). Lupus anticoagulant increased the risk of first CerVE (1.77; 0.99–3.16). Physician assessment indicated resolution or improvement in the majority but patients reported a sustained reduction in SF-36 summary and subscale scores following CerVEs (p<0.0001).
Conclusions CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus early in the disease course. In contrast to good physician reported outcomes, patients report a sustained reduction in health related quality of life following CerVEs.
- © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.