Age-Dependent Occurrence and Progression of White Matter Hyperintensities in Patients With Systemic Lupus Erythematosus

To elucidate the process of white matter hyperintensities (WMH) deterioration in SLE, we here report the occurrence of WMH on brain magnetic resonance imaging (MRI) by age group and the WMH deterioration rate in patients with SLE. Age-adjusted ratios of periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) in the SLE group (n = 142) were higher than those in the control group (n = 216, p = 0.003 and p < 0.0001, respectively). The difference was remarkable in middle-aged patients (≥40 and <60 years) (p < 0.0001 for PVH and DWMH). In middle-aged patients with SLE, WMH were associated with factors related to atherosclerosis, including hypertension (OR, 4.0; 95% CI, 1.1–15.8 for PVH and OR, 4.5; 95% CI, 1.1–18.5 for DWMH) and dyslipidemia (OR, 22.2; 95% CI, 1.6–300.5 for PVH). In Kaplan–Meier analysis, the overall rate of one grade WMH deterioration on the Fazekas scale was 8.2% per year after a 15-year follow-up (<60 years, n = 68). WMH in middle-aged patients declined more rapidly than younger patients. Our study reveals that middle-aged patients with SLE pose a risk for developing WMH because of atherosclerotic changes and also can have progressively worsening WMH.