Previous studies of stroke in systemic lupus erythematosus ( SLE ) have had limited statistical power, combined stroke subtypes into composite outcomes, and lacked a reference population estimate.
Therefore, researchers conducted a systematic review and meta-analysis of cohort studies to summarise the stroke subtype-specific risk in patients with systemic lupus erythematosus compared to the general population.
A systematic search of MEDLINE and EMBASE was performed for cohort studies examining the risk of stroke in systemic lupus erythematosus and including a general population comparator.
10 studies were included which reported relative risks ( RRs ) for overall stroke ( n=5 ), ischaemic stroke ( n=6 ), intracerebral haemorrhage ( n=3 ) and subarachnoid haemorrhage ( n=3 ).
The pooled RR for overall stroke was 2.53 ( 95% CI 1.96 to 3.26 ), ischaemic stroke 2.10 ( 95% CI 1.68 to 2.62 ), intracerebral haemorrhage 2.72 ( 95% CI 2.15 to 3.44 ) and subarachnoid haemorrhage 3.85 ( 95% CI 3.20 to 4.64 ).
Significant heterogeneity among studies for ischaemic stroke was detected ( p=0.002 ).
Relative risk of stroke was highest among individuals younger than 50 years of age. Individuals with systemic lupus erythematosus have a twofold higher risk of ischaemic stroke, a threefold higher risk of intracerebral haemorrhage, and an almost fourfold higher risk of subarachnoid haemorrhage compared to the general population.
Future studies should focus on whether comorbidity and disease flares are related to stroke, when individuals are at the highest risk, and how the targeting of specific groups of patients with systemic lupus erythematosus may reduce this risk. ( Xagena )
Holmqvist M et al, RMD Open 2015;1(1):e000168. doi: 10.1136/rmdopen-2015-000168. eCollection 2015.