Lupus: the new epidemic

Abstract

Is systemic lupus erythematosus (SLE) is occurring more frequently now than in decades past? Despite improvements in the identification of patients with SLE, the development of new classification criteria, and the recognition of several biomarkers used alone or in combination, the diagnosis of SLE is still a challenge for clinicians, in particular early in the course of the disease, which makes the recognition of secular trends difficult to ascertain. Lacking a uniform definition of preclinical lupus or incomplete lupus, it is difficult to predict accurately which patients would go on to develop SLE. We will briefly review the classification criteria, early or preclinical SLE, the epidemiology of SLE, antinuclear antibodies-negative SLE, and biomarkers of the disease.

Trends in mortality from lupus in Spain from 1980 to 2018

“…Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease, characterized by flares which can be associated with multiple organs damage and affects over five millions people worldwide. 1,2 International prevalence has been estimated from 30 to 150 per 100,000 and global incidence rate from 2,2 to 23,1 per 100,000 per year. 3 SLE prevalence in Spain has been reported as 210 cases per 100.000 inhabitants (95% CI 110, 400).…”

Deposition of Immune Complexes in Gingival Tissues in the Presence of Periodontitis and Systemic Lupus Erythematosus

“…From the panel of antibodies investigated, IgM was detected in seven SLE+, with weak (+) to strong (+ + +) scores, IgG and IgA were detected in one patient each and C3c was detected in 3 patients, compared to only one patient presenting immunostaining against IgM and C3c in only one SLE-patient (Supplementary Table 4). This finding might aid in the diagnosis of lupus, which is quite difficult to achieve due to the variability and complexity of clinical signs and symptoms, which may also manifest in diseases or conditions others than lupus (1).…”

“…The diagnosis of SLE is complex and relies on the presence of four signs and symptoms, necessarily including one clinical and one laboratorial finding or the biopsy-proven lupus nephritis (LN) (1). We have used antibodies against IgM, IgG, IgA, C1q and C3c, frequently used for the diagnosis of LN by direct immunofluorescence, to investigate the deposition of immune complexes in the gingival connective tissue in SLE patients compared to systemically healthy ones, both with periodontitis.…”

“…Deposition of immune complexes in lupus are usually higher at the diagnosis. The presence of lupus-associated autoantibodies may exist in apparently healthy individuals (38), some of which in the pre-clinical phase (1). Antibodies titers and types vary depending on the stage of development of the disease.…”

“…In the pre-clinical phase, 25% of the population is ANA positive in titers >1:40, 5% in titers ≥1:160 and 2% in titers considered as pathological (39). On the other hand, more than 99% of SLE patients are ANA-positive at some point during the course of the disease, besides the presence of other circulating autoantibodies, such as anti-Ro, anti-La, anti-phospholipids, anti-RNP and anti-dsDNA years before the clinical manifestation of SLE (1). The number of specific antibodies gradually increases in SLE up to the moment of diagnosis, and its accumulation decreases thereafter (40).…”