Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune disease that increases the risk for stroke. Here, we determined prevalence, stroke type, mechanism, and long-term outcome of patients with SLE-associated stroke.
Methods: From an institutional cohort of 4454 patients with SLE, we identified 131 with stroke. We collected demographical data, time elapsed between SLE diagnosis and stroke onset, and data related to specific stroke type.
Results: Prevalence of stroke in SLE was 2.9%. Figure shows the distribution of the stroke by type, as well as potential mechanisms. Median time from SLE diagnosis to stroke onset was 60 months (IQR 12-141) with high variability among stroke types. In 60% of patients with CVT and 30% of those with ischemic stroke, events occurred within the first 12 months of SLE diagnosis; indeed, stroke occurred prior to SLE (6%) or SLE was diagnosed during the clinical evaluation to ischemic stroke or CVT (10%). In contrast, 30% of ischemic strokes and 80% of hemorrhagic strokes occurred several years after diagnosis of SLE. An excellent clinical recovery at hospital discharge was observed in 68%. During a median follow-up of 84 months in 124 survivors of the acute phase, case fatality rate was 8.3%. Recurrence was observed in 7.2%.
Conclusion: Prevalence of stroke in this large cohort of SLE patients was 2.9%. CVT commonly occurred early after SLE diagnosis. Patients with ischemic strokes had a bimodal presentation, occurring either prior to -or shortly after- the diagnosis of SLE, or after a delay of several years. In contrast, 80% of hemorrhagic strokes occurred several years after diagnosis of SLE. Long-term clinical outcome was usually favorable.