Background/Purpose: Stroke is the most common arterial thrombotic event in SLE. It is known to be associated with antiphospholipid antibodies, but clinicians have additional concern about the contribution of SLE. We performed the first cluster analysis of stroke in a longitudinal SLE cohort.

Methods: There were 245 strokes in SLE patients confirmed by brain CT or MRI. Patients were 93.5% female, 50.5% Caucasian, and 45.3% African-American. Age at time of stroke was 41.5 ± 15.0 years (mean ± SD). Autoantibodies included lupus anticoagulant (dRVVT with confirmatory testing), anticardiolipin, anti-dsDNA, low C3, low C4, anti-Sm, anti-RNP, anti-Ro and anti-La. Analyses were done both without (Table 1, 214 patients) and with (Table 2, 145 patients) anti-beta2 glycoprotein 1, due to more missing data on anti-beta2 glycoprotein 1. Clustering was performed using Ward’s Hierarchical Clustering method (JMP v 13.0.0, SAS Institute Inc).

Results: Five clusters were identified. Cluster 5 (Table 1) and cluster 4 (Table 2) are an antiphospholipid cluster without strong serologic activity. Cluster 4 (Table 1) and Cluster 5 (Table 2) are clusters without antiphospholipid and without serologic activity. Clusters 1, 2 and 3 (Table 1) and clusters 2, 3 and to some extent cluster 1 (Table 2) are clusters with serologic activity. Clusters 2 and 3 (Table 1) and cluster 2 (Table 2) have strong anti-Sm and anti-RNP markers, and are associated with more African-American ethnicity compared to the other clusters combined (63.3% vs 42.3%, p=0.0136).

Conclusion: Stroke clustering identified 4 major serologic backgrounds for stroke in SLE: antiphospholipid alone, serologic markers alone, both antiphospholipid and serologic, and a group with neither. Some clusters represent stroke in predominantly African-American patients. These clusters may be helpful in formulating risk scores for stroke in SLE, in risk prevention, and eventually might be useful in treatment.

ACR 2019-Stroke Clusters in SLE by Lupus Autoantibodies-Table1

ACR 2019-Stroke Clusters in SLE by Lupus Autoantibodies-Table2

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/stroke-clusters-in-sle-by-lupus-autoantibodies/