PT  - JOURNAL ARTICLE
AU  - Marios Rossides
AU  - Julia F.  Simard
AU  - Elisabet Svenungsson
AU  - Mia von Euler
AU  - Elizabeth V.  Arkema
TI  - Mortality and Functionality after Stroke in Patients with Systemic Lupus Erythematosus
AID  - 10.3899/jrheum.170241
DP  - 2017 Sep 15
TA  - The Journal of Rheumatology
PG  - jrheum.170241
4099  - http://www.jrheum.org/content/early/2017/09/11/jrheum.170241.short
4100  - http://www.jrheum.org/content/early/2017/09/11/jrheum.170241.full
AB  - Objective To investigate mortality and functional impairment after stroke in systemic lupus erythematosus (SLE). Methods Using Swedish nationwide registers, we identified 423 individuals with SLE and 1652 people without SLE who developed a first-ever ischemic or hemorrhagic stroke (1998–2013) and followed them until all-cause death or for 1 year. HR for death after ischemic or hemorrhagic stroke and the risk ratio of functional impairment (dependence in either transferring, toileting, or dressing) 3 months after ischemic stroke were estimated. Results One year after stroke, 22% of patients with SLE versus 16% of those without SLE died. After ischemic stroke, patients with SLE had an increased risk of death (HR 1.85, 95% CI 1.39–2.45), which was attenuated after controlling for SLE-related comorbidities (HR 1.41, 95% CI 1.04–1.91). Functional impairment at 3 months was increased in SLE by almost 2-fold (risk ratio 1.73, 95% CI 1.16–2.57). After hemorrhagic stroke, patients with SLE had an HR of 2.30 (95% CI 1.38–3.82) for death, which was increased even during the first month. Conclusion Compared to subjects without SLE, mortality after ischemic stroke increases after the first month in individuals with SLE, and functionality is worse at 3 months. SLE is associated with all-cause death after hemorrhagic stroke even during the first month. A shift of focus to patient functionality and prevention of hemorrhagic strokes is required.