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
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