Lupus affects every organ in the body, including the heart, lungs, and blood vessels of the circulatory system. These symptoms can be devastating: People with systemic lupus erythematosus (SLE) also are at increased risk of developing cardiovascular disease, affecting the heart, lungs, kidneys, blood vessels, and even the chemistry of the blood itself. In particular, the risk of stroke (a blockage in the blood vessels that lead to the brain) is 4-times to 8-times higher in SLE patients, due to inflammation influencing the tendency of blood to clot and vasculitis stiffening the blood vessels.
For people with SLE, strokes are not only more likely to occur but 22% more likely to have poor outcomes. Strokes cause damage in the brain that can change the lives of people with lupus. Every aspect of life, from balance to cognition to fatigue, can be affected. Neurological disorders like seizures and dementia can be a result of a SLE-caused stroke. They can even be fatal.
Strokes in SLE also tend to happen in younger patients, often before diagnosis, making a stroke a potential “first symptom” that can indicate that lupus is there. 82.3% of people who experienced stroke had active (or probably active) lupus disease activity at the time.
Determining Stroke Risk with Lupus
The biggest risk for stroke seems to be within the first 5 years of active SLE, though this can be difficult to determine since stroke is sometimes the first symptom that hints at the presence of SLE, which may have been brewing for a while. Over a study with a follow up of 7 years, however, they still found an increased risk of stroke. Furthermore, this risk is even higher in black and Hispanic people with SLE.
Potential symptoms of lupus, such as fatigue, progressively increasing pain, light sensitivity, or the malar rash can signal the need for a closer look for lupus and stroke. Potential pre-stroke symptoms include fatigue, slowed or sluggish thoughts, being out of breath or easily exhausted, and poor circulation.
If these symptoms are present, or if the person is already known to have lupus, a reasonable next step towards determining stroke risk (and potentially diagnosing lupus) is a blood test, which detect risk factors for stroke.
In particular, antiphospholipid antibodies in the bloodstream, detected through blood tests, are a sign of SLE and are associated with cardiovascular symptoms like stroke. Blood tests can also be done for homocysteine. Homocysteine is normally broken down by various enzymes and picked up by other cells in the body. However, when there are vitamin B deficiencies or heart issues, it is not broken down. This leads to high quantities of homocysteine floating around in the bloodstream, making this amino acid a useful sign of potential heart disease. Homocysteine is also found in people with lupus who have a risk of stroke. A blood test for homocysteine may be a way that stroke risk – and SLE – can be detected.
However, less intense or obvious symptoms of lupus can easily fall through the cracks during checkups, and blood tests are often not done until lupus is in full effect. At that point, it can still be difficult to avoid a lupus-related stroke.
Treating Strokes and Lupus
Two thirds of stroke victims are able to recover almost completely, but people with lupus are more likely to have uneven recovery and, possibly, lingering issues. Physical and mental impairment is common, and all-cause death after the first month is even more so. In fact, ischemic (clotting) strokes or heart attacks account for 20-30% of deaths in SLE. This means that, for people with lupus, it is essential to prevent a stroke from happening in the first place.
Treatment with immunosuppressants, anti-inflammatories, and anticoagulants prevents strokes in people with SLE. One such anti-inflammatory drug, Hydroxychloroquine, also known as Plaquenil or HCQ, is an anti-malarial drug used to treat SLE. It treats pain, but also inflammation in general, reducing organ damage. Because it treats inflammation, the root cause of lupus, HCQ is useful for treating cardiovascular disease as well.
Exercise is also a powerful method for people with lupus to keep their hearts healthy. Fatigue and muscle weakness can be problematic, but there are ways around it. Read about good exercises for people with lupus here.
Talk to your lupus treatment team about other possibilities for preventing stroke, including heart-healthy diets and medication combinations.
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