TY - JOUR
T1 - Cerebrovascular Events in Systemic Lupus Erythematosus
T2 - Results From an International Inception Cohort Study
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
N1 - Funding Information:
part by an unrestricted grant (grant 201600000001387) from Hanyang University. Dr. Clarke holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Fortin’s work was supported in part by a Distinguished Senior Investigator Award from The Arthritis Society; he presently holds a Tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval. Dr. Bruce’s work was supported by Arthritis Research UK, the NIHR Biomedical Research Unit Funding Scheme, and The NIHR Manchester Biomedical Research Centre, and the
Funding Information:
Dr. Hanly’s work was supported by the Canadian Institutes of Health Research (grant MOP-88526). Drs. Su and Farewell’s work was supported by the Medical Research Council, UK (grant U105261167). Dr. Gordon’s work was supported by Lupus, UK and the NIHR/Wellcome Trust Clinical Research Facility. Dr. Bae’s work was supported in
Funding Information:
NIHR/Wellcome Trust Clinical Research Facility at Central Manchester Foundation Trust. Dr. Dooley’s work was supported by the NIH (grant RR-00046). Dr. Ramsey-Goldman’s work was supported by the NIH (grants 5-UL-1TR001422-02 [formerly 8-UL-1TR-000150] and UL-1RR-025741, K24-AR-02318, and P60-AR-64464 [formerly P60-AR-48098]). Dr. Ruiz-Irastorza’s work was supported by the Department of Education, Universities and Research of the Basque Government. Dr. Jacobsen’s work was supported by the Danish Rheumatism Association (grant A1028) and the Novo Nordisk Foundation (grant A05990). The John Hopkins Lupus Cohort is supported by the NIH (grants AR-43727 and AR-69572). The Montreal General Hospital Lupus Clinic is supported in part by the Singer Family Fund for Lupus Research.
Funding Information:
Dr. Hanly has received consulting fees from AstraZeneca (less than $10,000). Dr. Clark has received consulting fees from Medimmune/AstraZeneca, and Exagen Diagnostics (less than $10,000 each). Dr. Ginzler has received consulting fees from Ablynx (more than $10,000). Dr. von Vollenhoven has received research support and grants from AbbVie, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, and UCB (less than $10,000 each) and consulting fees or honoraria from AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, and UCB (less than $10,000 each). Dr. Inanc has received consulting fees from Merck Sharp & Dohme, AbbVie, Roche, Novartis, Bristol-Myers Squibb, and Pfizer (less than $10,000 each).
Publisher Copyright:
© 2018, American College of Rheumatology
PY - 2018/10
Y1 - 2018/10
N2 - Objective: To determine the frequency, characteristics, and outcomes of cerebrovascular events (CerVEs), as well as clinical and autoantibody associations in a multiethnic/racial inception cohort of patients with systemic lupus erythematosus (SLE). Methods: A total of 1,826 patients were assessed annually for 19 neuropsychiatric (NP) events, including 5 types of CerVEs: 1) stroke, 2) transient ischemia, 3) chronic multifocal ischemia, 4) subarachnoid/intracranial hemorrhage, and 5) sinus thrombosis. Global disease activity (Systemic Lupus Erythematosus Disease [SLE] Activity Index 2000), damage scores (SLE International Collaborating Clinics/American College of Rheumatology Damage Index), and Short Form 36 (SF-36) scores were collected. Time to event, linear and logistic regressions, and multistate models were used as appropriate. Results: CerVEs were the fourth most frequent NP event: 82 of 1,826 patients had 109 events; of these events, 103 were attributed to SLE, and 44 were identified at the time of enrollment. The predominant events were stroke (60 of 109 patients) and transient ischemia (28 of 109 patients). CerVEs were associated with other NP events attributed to SLE, non–SLE-attributed NP events, African ancestry (at US SLICC sites), and increased organ damage scores. Lupus anticoagulant increased the risk of first stroke and sinus thrombosis and transient ischemic attack. Physician assessment indicated resolution or improvement in the majority of patients, but patients reported sustained reduction in SF-36 summary and subscale scores following a CerVE. Conclusion: CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician-reported outcomes, patients reported a sustained reduction in health-related quality of life following a CerVE.
AB - Objective: To determine the frequency, characteristics, and outcomes of cerebrovascular events (CerVEs), as well as clinical and autoantibody associations in a multiethnic/racial inception cohort of patients with systemic lupus erythematosus (SLE). Methods: A total of 1,826 patients were assessed annually for 19 neuropsychiatric (NP) events, including 5 types of CerVEs: 1) stroke, 2) transient ischemia, 3) chronic multifocal ischemia, 4) subarachnoid/intracranial hemorrhage, and 5) sinus thrombosis. Global disease activity (Systemic Lupus Erythematosus Disease [SLE] Activity Index 2000), damage scores (SLE International Collaborating Clinics/American College of Rheumatology Damage Index), and Short Form 36 (SF-36) scores were collected. Time to event, linear and logistic regressions, and multistate models were used as appropriate. Results: CerVEs were the fourth most frequent NP event: 82 of 1,826 patients had 109 events; of these events, 103 were attributed to SLE, and 44 were identified at the time of enrollment. The predominant events were stroke (60 of 109 patients) and transient ischemia (28 of 109 patients). CerVEs were associated with other NP events attributed to SLE, non–SLE-attributed NP events, African ancestry (at US SLICC sites), and increased organ damage scores. Lupus anticoagulant increased the risk of first stroke and sinus thrombosis and transient ischemic attack. Physician assessment indicated resolution or improvement in the majority of patients, but patients reported sustained reduction in SF-36 summary and subscale scores following a CerVE. Conclusion: CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician-reported outcomes, patients reported a sustained reduction in health-related quality of life following a CerVE.
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U2 - 10.1002/acr.23509
DO - 10.1002/acr.23509
M3 - Article
C2 - 29316357
AN - SCOPUS:85052841350
VL - 70
SP - 1478
EP - 1487
JO - Arthritis Care and Research
JF - Arthritis Care and Research
SN - 2151-464X
IS - 10
ER -