Effects of Cerebrovascular Morbidity on Quality of Life in SLE

Cerebrovascular events (CerVEs), the fourth most common neuropsychiatric (NP) event reported in patients with systemic lupus erythematosus (SLE), are associated with both a short- and long-term impact on patient-reported health-related quality of life (HRQoL), according to the results of a recent international prospective cohort study conducted in 36 academic medical centers in 12 countries and published in Arthritis Care & Research.

All participants were evaluated yearly for 19 NP event types, including 5 types of CerVEs: (1) stroke, (2) transient ischemic attack (TIA), (3) chronic multifocal ischemia, (4) subarachnoid/ intracranial hemorrhage, and (5) sinus thrombosis. The investigators studied the frequency, attribution, clinical, and autoantibody associations of all CerVEs in the participants.

A total of 1826 patients with SLE were enrolled in the study. Of the participants, 88.8% were women and 48.8% were white. Mean patient age was 35.1±13.3; mean duration of disease was 5.6±4.2 months, and mean follow-up was 6.6±4.1 years. 

Overall, 4.5% of patients (82 of 1826) experienced 109 CerVEs, with 94.5% (103 of 109) of the events attributed to SLE and 40.4% (44 of 109) identified at study enrollment.

The CerVEs reported most often included stroke in 55.0% of patients (60 of 109) and transient ischemia in 25.7% of participants (28 of 109). CerVEs were associated with other NP events related to SLE (hazard ratio [HR], 3.16; 95% CI, 1.75 to 5.75; P <.001), non-SLE NP events (HR, 2.60; 95% CI, 1.49 to 4.51; P <.001), African ancestry at US Systemic Lupus International Collaborating Clinics (HR, 2.04; 95% CI, 1.01 to 4.13; P =.047), and organ damage (P =.041).

The presence of lupus anticoagulant increased the risk for first stroke and sinus thrombosis (HR, 2.23; 95% CI, 1.11 to 4.45; P =.024), as well as the risk for TIA (HR, 3.01; 95% CI, 1.15 to 7.90; P =.025). Although physician’s assessment demonstrated resolution or improvement in the majority of participants, patients reported significant sustained reductions in 36-item Short Form Survey (SF-36) summary and subscale scores following the occurrence of CerVEs (P <.0001).

The investigators concluded that CerVEs often present early in the course of SLE, and are linked to clinical and serologic variables. Based on patient-reported SF-36 scores, CerVEs appear to have a negative effect on HRQoL in individuals with SLE

Reference

Hanly JG, Li Q, Su L, Urowitz MB, e al. Cerebrovascular events in systemic lupus erythematosus [published online January 5, 2018]. Arthritis Care Res (Hoboken).doi:10.1002/acr.23509