NEW evidence from a retrospective cohort study in China highlights specific clinical and immunological factors associated with cerebral small vessel disease (CSVD) in patients with systemic lupus erythematosus (SLE), underscoring the need for earlier identification of high-risk individuals.
CSVD is increasingly recognised as an important contributor to neurological morbidity in SLE, yet its risk profile in this population remains incompletely defined. To address this gap, investigators analysed data from SLE patients treated at Zhong Da Hospital, affiliated with Southeast University in Nanjing, between June 2013 and April 2022. Patients with MRI-detected CSVD were compared with those without brain parenchymal lesions to identify distinguishing clinical and laboratory features.
Older Age and Higher Disease Activity
Among 100 patients included in the analysis, 60 were identified as having CSVD. Patients with CSVD were significantly older than those without imaging evidence of disease, with a median age of 48.5 years compared with 39.5 years. Disease duration and sex distribution were similar between groups, suggesting that age itself, rather than cumulative disease exposure, may play a central role in CSVD risk.
While overt clinical manifestations of SLE did not differ significantly, patients with CSVD had higher disease activity, reflected by increased SLEDAI scores. This finding supports a link between systemic inflammatory burden and cerebrovascular involvement.
Vascular and Immunological Associations
Hypertension was notably more prevalent in patients with CSVD, reinforcing the contribution of traditional vascular risk factors in SLE-related neurological disease. In addition, several immunological abnormalities were more common in the CSVD group, including positivity for anti-β2 glycoprotein I antibodies, low complement C3 levels, and prolonged activated partial thromboplastin time.
Multivariable logistic regression identified three independent risk factors for CSVD in SLE: increasing age, anti-β2GP1 antibody positivity, and low C3 levels. Patients positive for anti-β2GP1 antibodies or with reduced complement levels had nearly fourfold higher odds of CSVD, highlighting a potential role for antiphospholipid-related mechanisms and complement activation in cerebral microvascular injury.
Clinical Implications
The authors note that these findings have practical relevance for routine clinical care. Identifying older SLE patients with immunological markers such as anti-β2GP1 positivity or hypocomplementaemia may help clinicians recognise those at increased risk of silent or overt CSVD. Earlier MRI surveillance and more aggressive management of vascular and inflammatory risk factors could be considered in these individuals.
Although the retrospective design limits causal inference, the study provides valuable real-world insight into CSVD risk in SLE. The authors conclude that integrating age, immunological markers, and complement levels into clinical assessment may improve risk stratification and support more proactive neurological monitoring in patients with systemic lupus erythematosus.
Reference
Sun J et al. The risk factors of cerebral small vessel disease in patients with Systemic Lupus Erythematosus. BMC Rheumatol. 2025;DOI: 10.1186/s41927-025-00604-w.
