title: Cerebral Small Vessel Disease Burden Is Increased in Systemic Lupus Erythematosus.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Wiseman
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Mark E
authors.initials: ME
authors.lastname: Bastin
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Jardine
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Gayle
authors.initials: G
authors.lastname: Barclay
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Iona F
authors.initials: IF
authors.lastname: Hamilton
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Elaine
authors.initials: E
authors.lastname: Sandeman
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: David
authors.initials: D
authors.lastname: Hunt
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: E Nicole
authors.initials: EN
authors.lastname: Amft
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Susan
authors.initials: S
authors.lastname: Thomson
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Jill F F
authors.initials: JF
authors.lastname: Belch
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Ralston
authors.affiliation: From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.). joanna.wardlaw@ed.ac.uk.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000000981:diagnostic imaging; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology
keywords: C-reactive protein; autoimmune diseases; biomarkers; inflammation; systemic lupus erythematosus