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Response to: ‘Increased stroke incidence in systemic lupus erythematosus patients: risk factors or disease itself?’ by Bruzzese and Zullo
  1. Elizabeth V Arkema1,
  2. Marios Rossides1,
  3. Mia Von Euler2,
  4. Elisabet Svenungsson3,
  5. Christopher Sjöwall4,
  6. Julia F Simard1,5,6
  1. 1Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
  2. 2Clinical Science and Education and Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm
  4. 4Department of Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden
  5. 5Department of Health Research & Policy, Division of Epidemiology, Stanford School of Medicine, Stanford, California, USA
  6. 6Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Elizabeth V Arkema, Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm 17176, Sweden; elizabeth.arkema{at}

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We thank Dr Bruzzese and Dr Zullo for their interest in our study on stroke risk in systemic lupus erythematosus (SLE).1 In their letter, they speculate that it might not be SLE, per se, but other factors that could explain the increased risk.2 We would first like to emphasise that the purpose of our study was to determine whether individuals with SLE have a higher risk of stroke compared with the general population, not to determine how much of a role SLE plays in this risk or what the drivers of stroke are above and beyond SLE. Our study was designed so that the risk of stroke could be communicated to patients and clinicians.

Bruzzese and Zullo are interested in better understanding whether SLE plays an independent role in the aetiology of stroke, and suggest that the group of people with SLE with atrial fibrillation, congestive heart disease, hypertension and diabetes are driving …

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