Long-term outcomes in systemic lupus erythematosus: trends over time and major contributors

Abstract

SLE is a chronic autoimmune rheumatic disorder of high heterogeneity in clinical presentation, treatment response and prognosis. Long-term outcomes in SLE have been dramatically improved over the past decades, however, increased morbidity and mortality, especially among young individuals, still exists. Unmet needs include residual disease activity and frequent flares, glucocorticoid treatment dependency and toxicity, comorbidity burden, reduced health-related quality of life, health disparities and damage. The main determinants of long-term outcomes in SLE are age, sex, race/ethnicity, genetic profile, environmental factors including smoking, disease activity, major organ involvement such as lupus nephritis and CNS involvement, comorbidities including cardiovascular disease and serious infections, coexistence with APS, treatment adherence, socio-economic factors and access to care. In this review we discuss trends in long-term outcomes in SLE over the years and major contributors such as genetic, disease-related, treatment, comorbidity, socio-economic and other factors.

Comparison of Surrogate Markers of the Type I Interferon Response and Their Ability to Mirror Disease Activity in Systemic Lupus Erythematosus

“…Several reasons should be considered regarding the divergent results achieved herein compared to prior observations regarding associations of disease activity with CXCL8 ( 10 ) and galectin-9 ( 16 ). Ethnicity is closely related to genetics, severity of SLE and the type I IFN response ( 45 ). In addition, both the overall disease activity and the distribution of SLE phenotypes in the study populations are of relevance since certain manifestations and disease mechanisms may be more strongly linked to activation of type I IFNs than others.…”

The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

“…It is common feeling that the early diagnosis of SLE can be beneficial by allowing early intervention and potentially improving short and long-term outcomes [ 5 ]. There is few evidence supporting this assumption and mainly derives from administrative database analysis showing that the patients with early diagnosis (<6 months between probable SLE onset and diagnosis) had lower rates of flares and hospitalizations compared with the late diagnosis patients (≥6 months) [ 7 ].…”

“…Despite great improvements in treatment strategies leading to an improved prognosis [ 1 , 2 , 3 ], numerous challenges and unmet needs remain for the diagnosis and therapeutic management of Systemic Lupus Erythematosus (SLE) [ 4 , 5 ]. In this review we will provide an overview of the main unmet needs in the field of SLE ( Figure 1 ), as a way to inform physicians, policy makers, funding institutions, and more generally the broad scientific community about the challenges and opportunities which remain in SLE research and clinical care.…”

Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management

“…Physical exercise and psychological interventions also have proven benefits for fatigue in SLE, as well as depression and quality of life, demonstrating the similarities in effective strategies between the two conditions [79]. More simple measures, such as encouraging smoking cessation and a healthy diet, are likely to potentiate the effects of such self-management strategies-particularly the former, which adversely affects disease activity and response to treatment in both RA and SLE [33,[80][81][82].…”