Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects: Cardiovascular and Other Complications of Lupus
Session Type: Abstract Submissions (ACR)
Background/Purpose: Silent strokes are brain infarcts that lack clinically overt stroke-like symptoms and fail to come to clinical attention. The prevalence of incidentally detected acute/subacute silent brain infarcts (SBIs) in systemic lupus erythematosus (SLE) is not known. Our aim is to determine the prevalence of SBIs in SLE and examine their outcome.
Methods: Consecutive subjects drawn from the Maryland Lupus Cohort, aged 18–50 years who underwent a cranial MRI between 2000 and 2010 were included. A total of 376 eligible patients were identified: 30 did not undergo diffusion-weighted MR imaging and 32 patients had inadequate follow-up, leaving a study population of 314 patients. Incidental silent stroke was ascertained when focal T2 hyperintense lesions ≥3 mm on diffusion-weighted imaging with corresponding apparent diffusion coefficient defects were identified. Demographic and clinical data for SLE patients with SBIs (n=86) were compared to SLE patients with no SBIs (n=228). The primary outcome was recurrent stroke and cognitive dysfuction determined at mean follow up of 24 months. A forward stepwise Cox regression model was used to determine factors associated with recurrent stroke or cognitive dysfunction in SBIs patients. Significant variables; age, ethnicity, smoking, alcohol intake, and cardiovascular risk factors were included in the model. SLE disease activity (SLEDAI), damage (SDI) and duration of SLE were adjusted for during analyses.
Results:
86 of 314 (27.4 %) subjects had SBIs with a mean age (SBIs=37.3 +/- 12.1 years, No SBIs=34.7 +/- 14.7 years), women (SBIs=80 %, No SBIs=80 %), African American (SBIs=70 %, No SBIs= 65 %), and mean duration of SLE (SBIs= 9.0 + 3.6, No SBIs= 6.9 + 2.8 years). Hypertension (SBIs= 80 %, No SBI= 65 %), migraine with aura (SBIs 10.4 %, No SBIs= 2.6 %), and cardiovascular disease (SBIs= 11.6 %, No SBIs =1.7 %) were more frequent among patients with SBIs. There were no significant statistical differences among both groups with respect to baseline SLEDAI or SDI. SBIs were small and subcortical (basal ganglia 46.5 %, cerebellum 23.4 %, globus pallidus 7.0 %, corpus callosum 4.7 %).
Recurrent stroke occurred among SBIs patients (29%) and among those with no SBIs (6.5%), (p= 0.004). Independent predictors of recurrent stroke in SBIs patients included, anti-phospholipid syndrome [OR 12.0; 95% CI: 1.2-203.1].
A majority of the subjects with SBIs had significant cognitive impairment compared to no SBIs patients (60 % v 22%). SBIs patients had poorer memory and cognitive performance in all domains as compared to no SBI patients, including executive function, working memory, language, attention, and visuospatial abilities, but significantly in global cognition (48 % v 20 %) and information processing speed (42 % v 15 %). Independent predictors of cognitive dysfunction in SBIs patients included baseline presence of extensive white matter hyperintensity lesions in the periventricular and subcortical regions [OR: 10.1; 95 % CI: 1.1-98.4].
Conclusion: Silent strokes are prevalent in SLE, and are associated with recurrent strokes and cognitive dysfunction. Identifying novel risk factors that shed light on SBIs pathogenesis in SLE may offer potential therapeutic targets.
Disclosure:
J. Mikdashi,
None;
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcome-of-incidental-silent-strokes-in-systemic-lupus-erythematosus/