Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

Research output: Contribution to journalArticle


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.


  • John G. Hanly
  • Qiuju Li
  • Li Su
  • Murray B. Urowitz
  • Caroline Gordon
  • Sang Cheol Bae
  • Juanita Romero-Diaz
  • Jorge Sanchez-Guerrero
  • Sasha Bernatsky
  • Ann E. Clarke
  • Daniel J. Wallace
  • David A. Isenberg
  • Anisur Rahman
  • Joan T. Merrill
  • Paul Fortin
  • Dafna D. Gladman
  • Ian N. Bruce
  • Michelle Petri
  • Ellen M. Ginzler
  • M. A. Dooley
  • Kristjan Steinsson
  • Rosalind Ramsey-Goldman
  • Asad A. Zoma
  • Susan Manzi
  • Munther A. Khamashta
  • Graciela S. Alarcón
  • Winn Chatham
  • Ronald F. van Vollenhoven
  • Cynthia Aranow
  • Meggan Mackay
  • Guillermo Ruiz-Irastorza
  • Manuel Ramos-Casals
  • S. Sam Lim
  • Murat Inanc
  • Kenneth C. Kalunian
  • Soren Jacobsen
  • Christine A. Peschken
  • Diane L. Kamen
  • Anca Askanase
  • Chris Theriault
  • Vernon Farewell
External organisations
  • Dalhousie University
  • University of Cambridge
  • University of Toronto
  • University of Birmingham
  • Hanyang University
  • Instituto Nacional de Ciencias Médicas y Nutrición
  • McGill University
  • University of Calgary
  • Oklahoma Medical Research Foundation
  • Centre hospitalier universitaire de Québec
  • University of Manchester
  • State University of New York Downstate Medical Center
  • University of North Carolina
  • National University Hospital of Iceland
  • Hairmyres Hospital
  • Allegheny Health Network
  • University of Alabama
  • Karolinska Institutet
  • Feinstein Institute for Medical Research
  • University of the Basque Country
  • Hospital Clínic of Barcelona
  • Emory University
  • Istanbul University
  • University of California, San Diego
  • Copenhagen University Hospital
  • University of Manitoba
  • Medical University of South Carolina
  • New York University
  • Toronto Western Hospital
  • Cedars-Sinai Medical Center
  • University of California, Los Angeles
  • Central Manchester University Hospitals
  • Johns Hopkins University
  • Northwestern University
  • St Thomas' Hospital
  • King's College London
  • Gurutzeta/Cruces University Hospital
  • Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS)
  • University College London
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Rheumatology and Autoimmunity
Original languageEnglish
Pages (from-to)1478-1487
Number of pages10
JournalArthritis Care and Research
Issue number10
Publication statusPublished - 2018
Publication categoryResearch