Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus

Stewart J. Wiseman, Mark E. Bastin, Charlotte L. Jardine, Gayle Barclay, Iona F. Hamilton, Elaine Sandeman, David Hunt, E. Nicole Amft, Susan Thomson, Jill F. F. Belch, Stuart H. Ralston, Joanna M. Wardlaw (Lead / Corresponding author)

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Abstract

BACKGROUND AND PURPOSE: Systemic lupus erythematosus (SLE) increases stroke risk, but the mechanism is uncertain. This study aimed to determine the association between SLE and features on neuroimaging of cerebral small vessel disease (SVD), a risk factor for stroke.

METHODS: Consecutive patients attending a clinic for SLE were recruited. All patients underwent brain magnetic resonance imaging; had blood samples taken for markers of inflammation, endothelial dysfunction, cholesterol, and autoantibodies; and underwent cognitive and psychiatric testing. The data were compared with sex- and age-matched healthy controls and patients with minor stroke. Features of SVD were measured, a total SVD score calculated, and associations sought with vascular risk factors, cognition, SLE activity, and disease duration.

RESULTS: Fifty-one SLE patients (age: 48.8 years; SD: 14.3 years) had a greater total SVD score compared with healthy controls (1 versus 0; P<0.0001) and stroke patients (1 versus 0; P=0.02). There were higher perivascular spaces and deep white matter hyperintensity scores and more superficial brain atrophy in SLE patients versus healthy controls. Despite fewer vascular risk factors than similarly aged stroke patients, SLE patients had similar or more of some SVD features. The total SVD score was not associated with SLE activity, cognition, disease duration, or any blood measure.

CONCLUSIONS: In this data set, SLE patients had a high burden of SVD features on magnetic resonance imaging, particularly perivascular spaces. A larger longitudinal study is warranted to determine the causes of SVD features in SLE and clinical implications.

Original languageEnglish
Pages (from-to)2722-2728
Number of pages7
JournalStroke
Volume47
Issue number11
Early online date4 Oct 2016
DOIs
Publication statusPublished - Nov 2016

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Cerebral Small Vessel Diseases
Systemic Lupus Erythematosus
Stroke
Cognition
Magnetic Resonance Imaging
Brain
Neuroimaging
Autoantibodies
Atrophy
Psychiatry
Longitudinal Studies

Keywords

  • Autoimmune diseases
  • Biomarkers
  • C-reactive protein
  • Inflammation
  • Systemic Lupus Erythematosus

Cite this

Wiseman, S. J., Bastin, M. E., Jardine, C. L., Barclay, G., Hamilton, I. F., Sandeman, E., ... Wardlaw, J. M. (2016). Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus. Stroke, 47(11), 2722-2728. https://doi.org/10.1161/STROKEAHA.116.014330
Wiseman, Stewart J. ; Bastin, Mark E. ; Jardine, Charlotte L. ; Barclay, Gayle ; Hamilton, Iona F. ; Sandeman, Elaine ; Hunt, David ; Amft, E. Nicole ; Thomson, Susan ; Belch, Jill F. F. ; Ralston, Stuart H. ; Wardlaw, Joanna M. / Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus. In: Stroke. 2016 ; Vol. 47, No. 11. pp. 2722-2728.
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title = "Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus",
abstract = "BACKGROUND AND PURPOSE: Systemic lupus erythematosus (SLE) increases stroke risk, but the mechanism is uncertain. This study aimed to determine the association between SLE and features on neuroimaging of cerebral small vessel disease (SVD), a risk factor for stroke.METHODS: Consecutive patients attending a clinic for SLE were recruited. All patients underwent brain magnetic resonance imaging; had blood samples taken for markers of inflammation, endothelial dysfunction, cholesterol, and autoantibodies; and underwent cognitive and psychiatric testing. The data were compared with sex- and age-matched healthy controls and patients with minor stroke. Features of SVD were measured, a total SVD score calculated, and associations sought with vascular risk factors, cognition, SLE activity, and disease duration.RESULTS: Fifty-one SLE patients (age: 48.8 years; SD: 14.3 years) had a greater total SVD score compared with healthy controls (1 versus 0; P<0.0001) and stroke patients (1 versus 0; P=0.02). There were higher perivascular spaces and deep white matter hyperintensity scores and more superficial brain atrophy in SLE patients versus healthy controls. Despite fewer vascular risk factors than similarly aged stroke patients, SLE patients had similar or more of some SVD features. The total SVD score was not associated with SLE activity, cognition, disease duration, or any blood measure.CONCLUSIONS: In this data set, SLE patients had a high burden of SVD features on magnetic resonance imaging, particularly perivascular spaces. A larger longitudinal study is warranted to determine the causes of SVD features in SLE and clinical implications.",
keywords = "Autoimmune diseases, Biomarkers , C-reactive protein, Inflammation, Systemic Lupus Erythematosus",
author = "Wiseman, {Stewart J.} and Bastin, {Mark E.} and Jardine, {Charlotte L.} and Gayle Barclay and Hamilton, {Iona F.} and Elaine Sandeman and David Hunt and Amft, {E. Nicole} and Susan Thomson and Belch, {Jill F. F.} and Ralston, {Stuart H.} and Wardlaw, {Joanna M.}",
note = "This study was funded by Lupus UK. Data relating to the stroke patients was funded by the Wellcome Trust (WT088134/Z/09/A). Data relating to the controls was funded by the NIH (R01 EB004155-03).",
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Wiseman, SJ, Bastin, ME, Jardine, CL, Barclay, G, Hamilton, IF, Sandeman, E, Hunt, D, Amft, EN, Thomson, S, Belch, JFF, Ralston, SH & Wardlaw, JM 2016, 'Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus', Stroke, vol. 47, no. 11, pp. 2722-2728. https://doi.org/10.1161/STROKEAHA.116.014330

Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus. / Wiseman, Stewart J.; Bastin, Mark E.; Jardine, Charlotte L.; Barclay, Gayle; Hamilton, Iona F.; Sandeman, Elaine; Hunt, David; Amft, E. Nicole; Thomson, Susan; Belch, Jill F. F.; Ralston, Stuart H.; Wardlaw, Joanna M. (Lead / Corresponding author).

In: Stroke, Vol. 47, No. 11, 11.2016, p. 2722-2728.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus

AU - Wiseman, Stewart J.

AU - Bastin, Mark E.

AU - Jardine, Charlotte L.

AU - Barclay, Gayle

AU - Hamilton, Iona F.

AU - Sandeman, Elaine

AU - Hunt, David

AU - Amft, E. Nicole

AU - Thomson, Susan

AU - Belch, Jill F. F.

AU - Ralston, Stuart H.

AU - Wardlaw, Joanna M.

N1 - This study was funded by Lupus UK. Data relating to the stroke patients was funded by the Wellcome Trust (WT088134/Z/09/A). Data relating to the controls was funded by the NIH (R01 EB004155-03).

PY - 2016/11

Y1 - 2016/11

N2 - BACKGROUND AND PURPOSE: Systemic lupus erythematosus (SLE) increases stroke risk, but the mechanism is uncertain. This study aimed to determine the association between SLE and features on neuroimaging of cerebral small vessel disease (SVD), a risk factor for stroke.METHODS: Consecutive patients attending a clinic for SLE were recruited. All patients underwent brain magnetic resonance imaging; had blood samples taken for markers of inflammation, endothelial dysfunction, cholesterol, and autoantibodies; and underwent cognitive and psychiatric testing. The data were compared with sex- and age-matched healthy controls and patients with minor stroke. Features of SVD were measured, a total SVD score calculated, and associations sought with vascular risk factors, cognition, SLE activity, and disease duration.RESULTS: Fifty-one SLE patients (age: 48.8 years; SD: 14.3 years) had a greater total SVD score compared with healthy controls (1 versus 0; P<0.0001) and stroke patients (1 versus 0; P=0.02). There were higher perivascular spaces and deep white matter hyperintensity scores and more superficial brain atrophy in SLE patients versus healthy controls. Despite fewer vascular risk factors than similarly aged stroke patients, SLE patients had similar or more of some SVD features. The total SVD score was not associated with SLE activity, cognition, disease duration, or any blood measure.CONCLUSIONS: In this data set, SLE patients had a high burden of SVD features on magnetic resonance imaging, particularly perivascular spaces. A larger longitudinal study is warranted to determine the causes of SVD features in SLE and clinical implications.

AB - BACKGROUND AND PURPOSE: Systemic lupus erythematosus (SLE) increases stroke risk, but the mechanism is uncertain. This study aimed to determine the association between SLE and features on neuroimaging of cerebral small vessel disease (SVD), a risk factor for stroke.METHODS: Consecutive patients attending a clinic for SLE were recruited. All patients underwent brain magnetic resonance imaging; had blood samples taken for markers of inflammation, endothelial dysfunction, cholesterol, and autoantibodies; and underwent cognitive and psychiatric testing. The data were compared with sex- and age-matched healthy controls and patients with minor stroke. Features of SVD were measured, a total SVD score calculated, and associations sought with vascular risk factors, cognition, SLE activity, and disease duration.RESULTS: Fifty-one SLE patients (age: 48.8 years; SD: 14.3 years) had a greater total SVD score compared with healthy controls (1 versus 0; P<0.0001) and stroke patients (1 versus 0; P=0.02). There were higher perivascular spaces and deep white matter hyperintensity scores and more superficial brain atrophy in SLE patients versus healthy controls. Despite fewer vascular risk factors than similarly aged stroke patients, SLE patients had similar or more of some SVD features. The total SVD score was not associated with SLE activity, cognition, disease duration, or any blood measure.CONCLUSIONS: In this data set, SLE patients had a high burden of SVD features on magnetic resonance imaging, particularly perivascular spaces. A larger longitudinal study is warranted to determine the causes of SVD features in SLE and clinical implications.

KW - Autoimmune diseases

KW - Biomarkers

KW - C-reactive protein

KW - Inflammation

KW - Systemic Lupus Erythematosus

U2 - 10.1161/STROKEAHA.116.014330

DO - 10.1161/STROKEAHA.116.014330

M3 - Article

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JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 11

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Wiseman SJ, Bastin ME, Jardine CL, Barclay G, Hamilton IF, Sandeman E et al. Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus. Stroke. 2016 Nov;47(11):2722-2728. https://doi.org/10.1161/STROKEAHA.116.014330