Systemic lupus erythematosus is associated with an increased risk of cervical artery dissection

Abstract

Limited evidence suggests that autoimmune diseases are associated with an increased risk of cervical artery dissection (CeAD). We hypothesized individuals with systemic lupus erythematosus (SLE) would have an increased risk of CeAD following SLE diagnosis compared to matched non-lupus controls. We queried a de-identified United States electronic medical records network (TriNetX, Inc.) for individuals aged 10 and older from 2012 to 2020, for two cohorts: (1) SLE and (2) non-lupus controls, excluding those with prior CeAD. We used propensity matching to control for confounding variables and calculated the risk ratio (RR) for CeAD occurring over four years' follow-up, secondarily exploring cumulative incidence. After matching, both cohorts contained 77,008 patients, who were mostly female (89%). The incidence and risk of CeAD was significantly greater among those with SLE compared to matched non-lupus controls [95% CI] (0.08% vs. 0.04%; RR = 2.33 [1.49;3.66]; P < 0.0001). These findings support the hypothesis that SLE is a risk factor for CeAD. Additional research is needed to identify the mechanisms that may underly the SLE-CeAD association and examine the potential association between other autoimmune diseases and CeAD.

Fig. 1

Total incidence of cervical artery dissection (CeAD) over the four-year follow-up window. Incidences of CeAD are shown for the systemic lupus erythematosus cohort (SLE; pink) and non-lupus controls (green). Brackets indicate 95% confidence intervals.

Fig. 2

Cumulative incidence of cervical artery dissection (CeAD). Incidences of CeAD in the systemic lupus erythematosus cohort (SLE; pink) and non-lupus controls (green) are illustrated over the four-year follow-up period (1460 days). Shaded regions indicate 95% confidence intervals.