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Stroke in systemic lupus erythematosus: a Swedish population-based cohort study
  1. Elizabeth V Arkema1,
  2. Elisabet Svenungsson2,
  3. Mia Von Euler3,4,
  4. Christopher Sjöwall5,
  5. Julia F Simard1,6,7
  1. 1 Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
  4. 4 Stroke Research Network at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
  5. 5 Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden
  6. 6 Department of Health Research and Policy, Division of Epidemiology, Stanford School of Medicine, Stanford, California, USA
  7. 7 Department of Medicine, Division of Immunology and Rheumatology, Stanford School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Elizabeth V Arkema, Department of Medicine Solna, Clinical Epidemiology Unit T2, Karolinska Institutet, 17176 Stockholm, Sweden; elizabeth.arkema{at}


Objective To study the occurrence of ischaemic and haemorrhagic stroke in systemic lupus erythematosus (SLE) compared with the general population by age, sex and time since SLE diagnosis

Methods Adults with incident SLE were identified from the Swedish National Patient Register (NPR, n=3390) and general population comparators from the Total Population Register were matched on age, sex and county (n=16730). Individuals were followed prospectively until first of death, December 2013, emigration or incident stroke (identified from the NPR, Cause of Death Register and the Stroke Register). Incidence rates, rate differences and HR were estimated comparing SLE with non-SLE. Estimates were stratified by sex, age and time since diagnosis.

Results We observed 126 strokes in SLE and 304 in the general population. Individuals with SLE had a twofold increased rate of ischaemic stroke compared with the general population (HR 2.2; 95% CI 1.7 to 2.8). The HR for intracerebral haemorrhage was 1.4 (95% CI 0.7 to 2.8). There was effect modification by sex and age, with the highest HRs for females and individuals <50 years old. The HR for ischaemic stroke was highest in the first year of follow-up (3.7; 95% CI 2.1 to 6.5).

Conclusions The relative risk of ischaemic stroke in SLE was more than doubled compared with the general population, and importantly, the highest relative risks were observed within the first year after SLE diagnosis. Thus, the first encounter with patients presents an opportunity for rheumatologists to screen for risk factors and intervene.

  • systemic lupus erythematosus
  • epidemiology
  • cardiovascular disease

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  • Contributors EVA and JFS designed the study. EVA conducted the analyses and wrote the manuscript. All authors contributed to interpreting the results and revising the manuscript. All authors approved of the final version before submission.

  • Funding This study was funded by STROKE-Riksförbundet (The Swedish Stroke Association). This work was also supported by grants from the County Council of Östergötland, the Swedish Heart-Lung foundation, the Swedish Rheumatism Association, the Swedish Society of Medicine, the King Gustaf V 80-year foundation, the Swedish Research Council and grants provided by the Stockholm County Council (ALF project).

  • Competing interests None declared.

  • Patient consent No identifiable data was collected on patients and all information was anonymised.

  • Ethics approval Regional Ethics Review Board in Stockholm and Linkping.

  • Provenance and peer review Not commissioned; externally peer reviewed.