Abstract
Objective: The occurrence of ischemic stroke in patients with systemic lupus erythematosus (SLE) can cause extended periods of reduced daily activities. However, the risk factors for ischemic stroke in SLE patients are not fully elucidated. Herein, we examined the effect of white matter hyperintensities (WMH) on the occurrence of ischemic stroke in SLE patients.Methods: We analyzed the relationship between WMH burden and ischemic stroke using follow-up brain magnetic resonance imaging (MRI) data of 79 patients with SLE. Of these patients, 16 developed stroke during the observation period. WMH on MRI were classified into periventricular hyperintensities and deep white matter hyperintensities (DWMH), while the lesion extent was graded using the Fazekas scale.Results: Kaplan–Meier curves showed that ischemic stroke events were significantly associated with age at initial brain MRI of ≥40 years (p = 0.015) and history of anti-phospholipid syndrome (p = 0.030). Additionally, ischemic stroke events were significantly associated with a one grade deterioration of periventricular hyperintensities (p = 0.003) and a one grade deterioration of DWMH (p = 0.002). Multivariate analysis using the logistic regression model showed that a one grade deterioration of DWMH was an independent risk factor for ischemic stroke (hazard ratio, 6.0; 95% confidence interval, 1.3–27.4).Conclusions: Although several factors affect the occurrence of ischemic stroke, SLE patients show increased risk of ischemic stroke via development of DWMH. An observation of DWMH deterioration on follow-up brain MRI may be useful for assessing the risk of ischemic stroke in SLE patients.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of autoantibodies, immune complex deposition, and multiple target organ damage [1]
We investigated whether white matter hyperintensities (WMH) were a risk factor for the occurrence of ischemic stroke in SLE patients
At initial brain magnetic resonance imaging (MRI), periventricular hyperintensities (PVH) were observed in 23 patients (29.1%) and deep WMH (DWMH) were observed in 30 patients (38.0%)
Summary
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of autoantibodies, immune complex deposition, and multiple target organ damage [1]. The occurrence of SLE varies considerably worldwide [2]. In Japan, the prevalence of SLE ranges from 3.7 to 37.7 per 100,000 people. SLE mainly affects women in the 20–40-year age group [3, 4]. In an international cohort study, 40.3% of SLE patients showed neuropsychiatric symptoms during a mean observation period of 1.9 ± 1.2 years [5]. Cerebrovascular diseases often occur in SLE patients and cause a range of disturbances in daily living [7]. The risk of cerebral infarction in adult SLE patients was 2.18-fold higher than that in healthy individuals [8]. The risk factors for occurrence of ischemic stroke in SLE patients are poorly characterized
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