Cerebrovascular Events in Systemic Lupus Erythematosus

ObjectiveTo determine the frequency, associations and outcomes of cerebrovascular events (CerVEs) in a multi‐ethnic/racial, prospective, SLE disease inception cohort.MethodsPatients were assessed annually for 19 neuropsychiatric (NP) events including 5 types of CerVEs: (i) Stroke; (ii) Transient ischemia; (iii) Chronic multifocal ischemia; (iv) Subarachnoid/intracranial hemorrhage; (v) Sinus thrombosis. Global disease activity (SLEDAI‐2K), SLICC/ACR damage index (SDI) and SF‐36 scores were collected. Time to event, linear and logistic regressions and multi‐state models were used as appropriate. ResultsOf 1,826 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, 103/109 (94.5%) were attributed to SLE and 44/109 (40.4%) were identified at enrollment. The predominant events were stroke [60/109 (55.0%)] and transient ischemia [28/109 (25.7%)]. CerVEs were associated with other NP events attributed to SLE (HR (95% CI): (3.16; 1.73‐5.75) (p<0.001), non‐SLE NP (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 stroke and sinus thrombosis [2.23 (1.11, 4.45) p=.024] and TIA [3.01 (1.15, 7.90) p=0.025]. Physician assessment indicated resolution or improvement in the majority but patients reported sustained reduction in SF‐36 summary and subscale scores following CerVEs (P<0.0001). ConclusionCerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician reported outcomes, patients report a sustained reduction in health‐related quality of life following CerVEs.