Morbidity and Mortality in Systemic Lupus Erythematosus During a 10-Year Period

Abstract

In the present study, we assessed the frequency and characteristics of the main causes of morbidity and mortality in systemic lupus erythematosus (SLE) during a 10-year period and compared the frequency of early manifestations with those that appeared later in the evolution of the disease. In 1990, we started a multicenter study of 1,000 patients from 7 European countries. All had medical histories documented and underwent medical interview and routine general physical examination when entered in the study, and all were followed prospectively by the same physicians during the ensuing 10 years (1990-2000).A total of 481 (48.1%) patients presented 1 or more episodes of arthritis at any time during the 10 years, 311 (31.1%) patients had malar rash, 279 (27.9%) active nephropathy, 194 (19.4%) neurologic involvement, 166 (16.6%) fever, 163 (16.3%) Raynaud phenomenon, 160 (16.0%) serositis (pleuritis and/or pericarditis), 134 (13.4%) thrombocytopenia, and 92 (9.2%) thrombosis. When the prevalences of the clinical manifestations during the initial 5 years of follow-up (1990-1995) were compared with those during the ensuing 5 years (1995-2000), most manifestations were found to be more frequent during the initial 5 years. Of the 1,000 patients, 360 (36%) presented infections, 169 (16.9%) hypertension, 121 (12.1%) osteoporosis, and 81 (8.1%) cytopenia due to immunosuppressive agents. Twenty-three (2.3%) patients developed malignancies; the most frequent primary localizations were the uterus and the breast.Sixty-eight (6.8%) patients died, and the most frequent causes of death were similarly divided between active SLE (26.5%), thromboses (26.5%), and infections (25%). A survival probability of 92% at 10 years was found. A lower survival probability was detected in those patients who presented at the beginning of the study with nephropathy (88% versus 94% in patients without nephropathy, p = 0.045). When the causes of death during the initial 5 years of follow-up (1990-1995) were compared with those during the ensuing 5 years (1995-2000), active SLE and infections (28.9% each) appeared to be the most common causes during the initial 5 years, while thromboses (26.1%) became the most common cause of death during the last 5 years.In conclusion, most of the SLE inflammatory manifestations appear to be less common after a long-term evolution of the disease, probably reflecting the effect of therapy as well as the progressive remission of the disease in many patients. Meanwhile, a more prominent role of thrombotic events is becoming evident, affecting both morbidity and mortality in SLE.

Clinical picture of lupus nephritis in patients with systemic lupus erythematosus (SLE): Results of a large survey

“…The overall prevalence rate of lupus nephritis was higher in the current study compared to notable surveys [22,23]. It is noteworthy that previous studies have suggested that the highest rate of renal involvement in the world (73%) was found in Indo-Asians [16,24].…”

RETRACTED ARTICLE: Purified umbilical cord derived mesenchymal stem cell treatment in a case of systemic lupus erythematosus

“…Therapeutic options for CTD have been less than satisfactory; anti-inflammatories and immunosuppressants have been the primary focus since no cure is known at this time. Long-term immunosuppressants and anti-inflammatories carry significant morbidity, estimated mortality is 6.8% while the most frequent predictors are: active SLE, thromboses, and infections, respectively [1].…”

Reversal of Established Lupus Nephritis and Prolonged Survival of New Zealand Black × New Zealand White Mice Treated with the Topoisomerase I Inhibitor Irinotecan

“…The 5-y survival rate of patients with lupus-associated glomerulonephritis increased from 44% in the 1950s to 82% recently (2). Despite clear advances in the treatment of this autoimmune disease, the mean age of death of patients dying from systemic lupus erythematosus is 44 y (3).…”