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Evaluation of Stroke Patients Diagnosed with Rheumatologic Diseases

Year 2024, Volume: 34 Issue: 3, 408 - 412
https://doi.org/10.54005/geneltip.1482802

Abstract

Objective: Some comorbid diseases are recognized as specific risk factors for stroke. Rheumatological diseases constitute an important group of these diseases. In our study, we evaluated patients who were followed up for stroke in our clinic. We included patients with additional rheumatological diagnoses in a separate group and attempted to determine their differences from patients without a diagnosis. In this way, we aim to investigate the effect of rheumatological comorbidity on prognosis in stroke patients.
Material and methods: We included patients diagnosed with ischemic stroke, hemorrhagic stroke, transient ischemic attack, and hemorrhagic infarction, who were admitted to our hospital between 2016-2020 and were hospitalized, in the study. Age, gender, stroke subtype, need for intensive care, and exitus status of these patients was recorded. We compared patients with a rheumatological diagnosis to patients with other stroke diagnoses using appropriate statistical methods.
Results: 2053 patients with an average age of 66.22±14.33 participated in the study. A total of 37 patients were diagnosed with at least 1 rheumatological disease. We calculated the average age of these patients as 51.62±15.88. Compared to patients without a diagnosis of rheumatological disease, the age was significantly lower(p<0.001). However, we did not find a significant relationship between the distribution of stroke subtypes(p=0.538), and there was no significant difference in terms of gender(p=0.149). No statistical significance was observed in intensive care unit admissions and exitus rates.(p=0.384,0.868)
Conclusion: Some rheumatologic diseases are known to be linked to stroke risk. In our study, we did not observe a significant difference between the groups in terms of prognosis. Having a history of stroke is an independent risk factor for developing stroke in the future. We believe that since patients with a rheumatological diagnosis have a stroke at a younger age, their risk of a subsequent stroke increases, and their follow-up should be more frequent.

Ethical Statement

The study protocol was approved by the Selcuk University Clinical Researches Local Ethics Committee (Approval number: 2020-473). Our study was conducted according to the criteria set in the Declaration of Helsinki.

References

  • Potter TBH, Tannous J and Vahidy FS. A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke. Curr Atheroscler Rep 2022; 24: 939-948. 20221114. DOI: 10.1007/s11883-022-01067-x.
  • van Alebeek ME, Arntz RM, Ekker MS, et al. Risk factors and mechanisms of stroke in young adults: The FUTURE study. J Cereb Blood Flow Metab 2018; 38: 1631-1641. 20170523. DOI: 10.1177/0271678x17707138.
  • Adams HP, Jr., Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41. DOI: 10.1161/01.str.24.1.35.
  • Younger DS. Stroke due to Vasculitis in Children and Adults. Neurol Clin 2019; 37: 279-302. DOI: 10.1016/j.ncl.2019.01.004.
  • Pavlakis PP. Rheumatologic Disorders and the Nervous System. Continuum (Minneap Minn) 2020; 26: 591-610. DOI: 10.1212/con.0000000000000856.
  • Hanly JG, Li Q, Su L, et al. Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Care Res (Hoboken) 2018; 70: 1478-1487. 20180901. DOI: 10.1002/acr.23509.
  • Mittal P, Quattrocchi G, Tohidi-Esfahani I, et al. Antiphospholipid syndrome, antiphospholipid antibodies, and stroke. Int J Stroke 2023; 18: 383-391. 20230125. DOI: 10.1177/17474930221150349.
  • Holmqvist M, Simard JF, Asplund K, et al. Stroke in systemic lupus erythematosus: a meta-analysis of population-based cohort studies. RMD Open 2015; 1: e000168. 20151216. DOI: 10.1136/rmdopen-2015-000168.
  • Fragoulis GE, Panayotidis I and Nikiphorou E. Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment. Curr Vasc Pharmacol 2020; 18: 431-446. DOI: 10.2174/1570161117666190619143842.
  • Duarte MM, Geraldes R, Sousa R, et al. Stroke and Transient Ischemic Attack in Takayasu's Arteritis: A Systematic Review and Meta-analysis. J Stroke Cerebrovasc Dis 2016; 25: 781-791. 20160113. DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.005.
  • de Boysson H, Liozon E, Espitia O, et al. Different patterns and specific outcomes of large-vessel involvements in giant cell arteritis. J Autoimmun 2019; 103: 102283. 20190524. DOI: 10.1016/j.jaut.2019.05.011.
  • de Boysson H and Guillevin L. Polyarteritis Nodosa Neurologic Manifestations. Neurol Clin 2019; 37: 345-357. 20190316. DOI: 10.1016/j.ncl.2019.01.007.
  • Wu CY, Yu HS, Chai CY, et al. Increased ischemic stroke risk in patients with Behçet's disease: A nationwide population-based cohort study. PLoS One 2019; 14: e0218652. 20190625. DOI: 10.1371/journal.pone.0218652.
  • Aviña-Zubieta JA, Mai A, Amiri N, et al. Risk of Myocardial Infarction and Stroke in Patients With Granulomatosis With Polyangiitis (Wegener's): A Population-Based Study. Arthritis Rheumatol 2016; 68: 2752-2759. 20160929. DOI: 10.1002/art.39762.
  • Kaiser D, Leonhardt GK, Weiss N, et al. Pearls & Oy-sters: Primary Cerebral Buerger Disease: A Rare Differential Diagnosis of Stroke in Young Adults. Neurology 2021; 97: 551-554. 20210430. DOI: 10.1212/wnl.0000000000012140.
  • Misra DP, Sharma A, Karpouzas GA, et al. Cardiovascular risk in vasculitis. Best Pract Res Clin Rheumatol 2023; 37: 101831. 20230609. DOI: 10.1016/j.berh.2023.101831.

İnme Geçiren Romatolojik Hastalık Tanılı Hastaların Değerlendirilmesi

Year 2024, Volume: 34 Issue: 3, 408 - 412
https://doi.org/10.54005/geneltip.1482802

Abstract

Amaç: Komorbid hastalıkların bazılarının inme için özellikle risk faktörü olduğu bilinmektedir. Bu hastalıklar içinde önemli bir grubu da romatolojik hastalıklar oluşturmaktadır. Çalışmamızda kliniğimizde inme nedeni ile takip edilen hastalar değerlendirilmiş ek romatolojik tanısı bulunan hastalar ayrı bir gruba alınarak tanısı olmayan hastalardan farklılıkları saptanmaya çalışılmıştır. Bu sayede inme hastalarında romatolojik komorbiditenin prognoz üzerine etkisini araştırmayı amaçlıyoruz.
Gereç ve Yöntem: Çalışmaya 2016-2020 tarihleri arasında hastanemize başvuran ve yatırılarak takip edilen iskemik inme, hemorajik inme, geçici iskemik atak, hemorajik enfarkt tanılı hastalar dahil edildi. Bu hastaların yaş, cinsiyet, inme alttipi, komorbid hastalık alttipi, yoğun bakım ihtiyacı, exitus durumları kayıt altına alındı. Romatolojik tanıya sahip olan hastalar diğer inme tanılı hastalarla uygun istatistiksel yöntemler kullanılarak karşılaştırıldı.
Bulgular: Çalışmaya yaş ortalaması 66.2214.33 olan 2053 hasta katıldı. Bu hastaların 37 tanesinde en az 1 romatolojik hastalık tanısı bulunmaktaydı. Bu hastaların yaş ortalaması 51.6215.88 olarak hesaplandı. Romatolojik hastalık tanısı bulunmayan hastalarla kıyaslandığında yaş anlamlı olarak daha düşük izlendi (p<0.001). Ancak inme alttiplerinin dağılımı açısından anlamlı ilişki yoktu(p=0.538), cinsiyetler açısından anlamlı farklılık izlenmedi(p=0.149). Yoğun bakım yatışları ve exitus oranları arasında istatistiksel anlamlılık yoktu (p=0.384,0.868).
Sonuç: Bazı romatolojik hastalıkların inme için risk faktörü olduğu bilinmektedir. Çalışmamızda prognoz açısından gruplar arası belirgin farklılık izlenmedi. Bu nedenle romatolojik tanısı bulunan hastaların inme prognozu genel popülasyonla benzer olarak değerlendirilebilir. Geçmişinde inme öyküsü olması gelecekte inme gelişmesi açısında bağımsız bir risk faktörüdür. Romatolojik tanısı bulunan hastaların daha genç yaşta inme geçirmeleri nedeniyle bir sonraki inme açısından riskleri artmakta ve takiplerinin daha sık olması gerektiği kanaatindeyiz.

References

  • Potter TBH, Tannous J and Vahidy FS. A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke. Curr Atheroscler Rep 2022; 24: 939-948. 20221114. DOI: 10.1007/s11883-022-01067-x.
  • van Alebeek ME, Arntz RM, Ekker MS, et al. Risk factors and mechanisms of stroke in young adults: The FUTURE study. J Cereb Blood Flow Metab 2018; 38: 1631-1641. 20170523. DOI: 10.1177/0271678x17707138.
  • Adams HP, Jr., Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41. DOI: 10.1161/01.str.24.1.35.
  • Younger DS. Stroke due to Vasculitis in Children and Adults. Neurol Clin 2019; 37: 279-302. DOI: 10.1016/j.ncl.2019.01.004.
  • Pavlakis PP. Rheumatologic Disorders and the Nervous System. Continuum (Minneap Minn) 2020; 26: 591-610. DOI: 10.1212/con.0000000000000856.
  • Hanly JG, Li Q, Su L, et al. Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Care Res (Hoboken) 2018; 70: 1478-1487. 20180901. DOI: 10.1002/acr.23509.
  • Mittal P, Quattrocchi G, Tohidi-Esfahani I, et al. Antiphospholipid syndrome, antiphospholipid antibodies, and stroke. Int J Stroke 2023; 18: 383-391. 20230125. DOI: 10.1177/17474930221150349.
  • Holmqvist M, Simard JF, Asplund K, et al. Stroke in systemic lupus erythematosus: a meta-analysis of population-based cohort studies. RMD Open 2015; 1: e000168. 20151216. DOI: 10.1136/rmdopen-2015-000168.
  • Fragoulis GE, Panayotidis I and Nikiphorou E. Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment. Curr Vasc Pharmacol 2020; 18: 431-446. DOI: 10.2174/1570161117666190619143842.
  • Duarte MM, Geraldes R, Sousa R, et al. Stroke and Transient Ischemic Attack in Takayasu's Arteritis: A Systematic Review and Meta-analysis. J Stroke Cerebrovasc Dis 2016; 25: 781-791. 20160113. DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.005.
  • de Boysson H, Liozon E, Espitia O, et al. Different patterns and specific outcomes of large-vessel involvements in giant cell arteritis. J Autoimmun 2019; 103: 102283. 20190524. DOI: 10.1016/j.jaut.2019.05.011.
  • de Boysson H and Guillevin L. Polyarteritis Nodosa Neurologic Manifestations. Neurol Clin 2019; 37: 345-357. 20190316. DOI: 10.1016/j.ncl.2019.01.007.
  • Wu CY, Yu HS, Chai CY, et al. Increased ischemic stroke risk in patients with Behçet's disease: A nationwide population-based cohort study. PLoS One 2019; 14: e0218652. 20190625. DOI: 10.1371/journal.pone.0218652.
  • Aviña-Zubieta JA, Mai A, Amiri N, et al. Risk of Myocardial Infarction and Stroke in Patients With Granulomatosis With Polyangiitis (Wegener's): A Population-Based Study. Arthritis Rheumatol 2016; 68: 2752-2759. 20160929. DOI: 10.1002/art.39762.
  • Kaiser D, Leonhardt GK, Weiss N, et al. Pearls & Oy-sters: Primary Cerebral Buerger Disease: A Rare Differential Diagnosis of Stroke in Young Adults. Neurology 2021; 97: 551-554. 20210430. DOI: 10.1212/wnl.0000000000012140.
  • Misra DP, Sharma A, Karpouzas GA, et al. Cardiovascular risk in vasculitis. Best Pract Res Clin Rheumatol 2023; 37: 101831. 20230609. DOI: 10.1016/j.berh.2023.101831.
There are 16 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Original Article
Authors

Cihat Özgüncü 0000-0001-7755-9409

Şerefnur Öztürk 0000-0001-8986-155X

Gökhan Özdemir 0000-0001-8140-6333

Early Pub Date June 15, 2024
Publication Date
Submission Date May 14, 2024
Acceptance Date June 12, 2024
Published in Issue Year 2024 Volume: 34 Issue: 3

Cite

Vancouver Özgüncü C, Öztürk Ş, Özdemir G. Evaluation of Stroke Patients Diagnosed with Rheumatologic Diseases. Genel Tıp Derg. 2024;34(3):408-12.