Stroke in autoimmune rheumatic diseases

Stroke is a major cause of mortality and long-term disability worldwide. Patients with autoimmune rheumatic diseases (ARDs) exhibit a significantly increased risk of both ischemic and hemorrhagic strokes, particularly at younger age. Systemic inflammation, immune-mediated vascular injury, antiphospholipid antibodies, accelerated atherosclerosis, and comorbidities contribute to this elevated cerebrovascular burden. This review aims to comprehensively overview stroke epidemiology, pathophysiological mechanisms, clinical characteristics, prevention strategies, and post-stroke rehabilitation in patients with ARDs. Literature searches were conducted using Medline/PubMed, Scopus, Web of Science, and the Directory of Open Access Journals (DOAJ) databases up to February 1, 2026. Studies evaluating stroke incidence, risk factors, mechanistic pathways, prevention approaches, and rehabilitation in rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, ankylosing spondyloarthritis, systemic vasculitides, and Behçet disease were included. Stroke risk is markedly increased across ARDs, with relative risks ranging from 1.3 to 2.5, depending on disease subtype. Systemic lupus erythematosus and systemic vasculitides confer particularly high cerebrovascular risk, often presenting at younger age and associated with worse functional outcomes. Chronic systemic inflammation, endothelial dysfunction, autoantibody-mediated thrombosis, genetic susceptibility, and accelerated atherosclerosis represent central mechanistic pathways. Certain immunomodulatory therapies may mitigate stroke risk through inflammation control, whereas others require careful cardiovascular risk assessment. Post-stroke recovery may be adversely influenced by persistent inflammatory activity and musculoskeletal comorbidities, underscoring the importance of multidisciplinary management. Early risk stratification, tight control of systemic inflammation, individualized immunomodulatory therapy, and structured rehabilitation strategies are essential to improve cerebrovascular outcomes in ARDs. Future research should focus on personalized risk prediction models and targeted preventive interventions in this high-risk population.