Cerebral small vessel disease (CSVD) is an increasingly recognised neurological complication in patients with systemic lupus erythematosus (SLE), contributing to cognitive impairment, stroke risk, and reduced quality of life. New research identifies key clinical and immunological factors associated with CSVD in patients with SLE, offering insight into those at greatest risk.
Study Design and Patient Characteristics
Researchers conducted a retrospective analysis of 100 patients with SLE treated at Zhong Da Hospital in China between 2013 and 2022. All patients underwent brain MRI, allowing investigators to compare those with imaging-confirmed CSVD (n=60) to those without brain parenchymal lesions.
Patients with CSVD were significantly older than those without CSVD, with a median age of 48.5 years compared with 39.5 years. Disease duration and sex distribution did not differ between groups. However, patients with CSVD had higher disease activity, reflected by increased SLEDAI scores.
Key Risk Factors Linked to CSVD
Several vascular and immunological differences emerged between groups. Hypertension was more prevalent in patients with CSVD, affecting 28.3% compared with 10.0% of controls. Immunological markers also differed substantially: anti-β2 glycoprotein I antibody positivity was observed in just over half of CSVD cases versus 23.1% of controls, and low complement C3 levels were significantly more common.
Patients with CSVD also demonstrated prolonged activated partial thromboplastin time, suggesting an underlying prothrombotic or inflammatory state. Multivariate logistic regression identified three independent risk factors for CSVD development: older age, anti-β2GP1 antibody positivity, and reduced C3 levels.
Clinical Implications for Lupus Management
The findings highlight a distinct risk profile for CSVD in SLE, combining age-related vulnerability with immune-mediated vascular injury. The association with antiphospholipid antibodies and complement consumption underscores the role of immune dysregulation in cerebrovascular damage.
Early identification of high-risk patients may support more targeted monitoring and preventative strategies, including aggressive management of hypertension and closer neurological surveillance. While limited by its retrospective design and single-centre setting, the study provides clinically relevant signals that warrant further prospective investigation.
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.
