TY - JOUR
T1 - Cerebrovascular Events in Systemic Lupus Erythematosus
AU - Hanly, John G.
AU - Li, Qiuju
AU - Su, Li
AU - Urowitz, Murray B.
AU - Gordon, Caroline
AU - Bae, Sang-Cheol
AU - Romero-Diaz, Juanita
AU - Sanchez-Guerrero, Jorge
AU - Bernatsky, Sasha
AU - Clarke, Ann E.
AU - Wallace, Daniel J.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Merrill, Joan T.
AU - Fortin, Paul
AU - Gladman, Dafna D.
AU - Bruce, Ian N.
AU - Petri, Michelle
AU - Ginzler, Ellen M.
AU - Dooley, M. A.
AU - Steinsson, Kristjan
AU - Ramsey-Goldman, Rosalind
AU - Zoma, Asad A.
AU - Manzi, Susan
AU - Nived, Ola
AU - Jonsen, Andreas
AU - Khamashta, Munther A.
AU - Alarcón, Graciela S.
AU - Chatham, Winn
AU - van Vollenhoven, Ronald F.
AU - Aranow, Cynthia
AU - Mackay, Meggan
AU - Ruiz-Irastorza, Guillermo
AU - Ramos-Casals, Manuel
AU - Lim, S. Sam
AU - Inanc, Murat
AU - Kalunian, Kenneth C.
AU - Jacobsen, Soren
AU - Peschken, Christine A.
AU - Kamen, Diane L.
AU - Askanase, Anca
AU - Theriault, Chris
AU - Farewell, Vernon
PY - 2018
Y1 - 2018
N2 - To determine the frequency, associations and outcomes of cerebrovascular events (CerVEs) in a multi-ethnic/racial, prospective, SLE disease inception cohort. Patients 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. Of 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). CerVEs, 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. This article is protected by copyright. All rights reserved
AB - To determine the frequency, associations and outcomes of cerebrovascular events (CerVEs) in a multi-ethnic/racial, prospective, SLE disease inception cohort. Patients 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. Of 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). CerVEs, 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. This article is protected by copyright. All rights reserved
U2 - https://doi.org/10.1002/acr.23509
DO - https://doi.org/10.1002/acr.23509
M3 - Article
C2 - 29316357
SN - 2151-464X
VL - 70
SP - 1478
EP - 1487
JO - Arthritis care & research
JF - Arthritis care & research
IS - 10
ER -