Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: a multicentric observational study.

Autor: Geraldes R; Neurology Department, Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK. ruth.geraldes@ndcn.ox.ac.uk.; Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK. ruth.geraldes@ndcn.ox.ac.uk., Santos M; Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.; Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal., Ponte C; Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal., Craven A; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK., Barra L; Lawson Health Research Institute, London, ON, Canada., Robson JC; Centre for Health and Clinical Research, University of the West of England, Bristol, UK., Hammam N; Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt., Springer J; University of Kansas Medical Centre Institute, Lawrence, Kansas, KS, USA., Henes J; Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-Inflammatory Diseases, Department of Internal Medicine II (Oncology, Haematology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany., Hocevar A; University Medical Centre Ljubljana, Ljubljana, Slovenia., Putaala J; Helsinki University Central Hospital, Helsinki, Finland., Santos E; Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal., Rajasekhar L; NIMS, Hyderabad, India., Daikeler T; Department of Rheumatology and Clinical Research, University Hospital, Basel, Switzerland., Karadag O; Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Ankara, Turkey., Costa A; Centro Hospitalar Universitário de São João, Porto, Portugal.; Neuroscience and Mental Health Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal., Khalidi N; Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada., Pagnoux C; Mount Sinai Hospital, Toronto, Canada., Canhão P; Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.; Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal., Melo TPE; Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.; Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal., Fonseca AC; Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.; Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal., Ferro JM; Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal., Fonseca JE; Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal., Suppiah R; Te Whatu Ora-Health, Wellington, New Zealand., Watts RA; Norwich Medical School, Norwich, UK., Grayson P; National Institutes of Health, NIAMS Vasculitis Translational Research Program, Bethesda, USA., Merkel PA; Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, USA.; Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, USA., Luqmani RA; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2024 Jun; Vol. 271 (6), pp. 3309-3320. Date of Electronic Publication: 2024 Mar 12.
DOI: 10.1007/s00415-024-12251-1
Abstrakt: Objectives: The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV.
Methods: Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed.
Results: The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00-4.06): 102 (2.13% 95% CI 1.73-2.56) with stroke and 81 (1.68% 95% CI 1.33-2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet's disease (9.5%, 95% CI 5.79-14.37), polyarteritis nodosa (6.2%, 95% CI 3.25-10.61), and Takayasu's arteritis (6.0%, 95% CI 4.30-8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09-3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20-3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05-9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01-2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period.
Conclusion: CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet's. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence.
(© 2024. The Author(s).)
Databáze: MEDLINE
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