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Objective To investigate all-cause and cause-specific mortality in SLE patients between two time periods, 1997-2005 and 2006-2014. Methods We used an administrative health database from the province of British Columbia, Canada to match all incident SLE patients to 10 non-SLE individuals on sex, age and index date. Cohorts were divided into two sub-groups, according to diagnosis year: early cohort 1997-2005 and late cohort 2006-2014. The outcome was death (all-cause, renal disease, cancer, infection, cardiovascular disease (CVD), and other). Hazard ratios (HR and 95% confidence intervals) were estimated using univariate and multivariable Cox models. Results Among 6,092 SLE patients and 60,920 non-SLE individuals, there were 451 and 1,910 deaths, respectively. The fully-adjusted all-cause mortality HR (95% CI) in the overall SLE cohort was 1.85 (1.66-2.06), with no statistically significant improvement between early and late cohorts (1.95 (1.69-2.26) versus 1.74 (1.49-2.04). There was excess mortality from renal disease (3.04 (2.29-4.05)), infections (2.74 (2.19-3.43)) and CVD (2.05 (1.77-2.38)), but not cancer (1.18 (0.96-1.46)), in the overall SLE cohort. There was no statistically significant improvement in cause-specific mortality between early and late cohorts for renal disease (3.57 (2.37-5.36) versus 2.65 (1.78-3.93)), infection (2.94 (2.17-3.98) versus 2.54 (1.84-3.51)), and CVD (1.95 (1.60-2.38) versus 2.18 (1.76-2.71)). There was no increase in cancer-related mortality in either cohort (1.27 (0.96-1.69) versus 1.10 (0.82-1.48)). Conclusion This population-based study demonstrates a persisting mortality gap in all-cause and cause-specific deaths in SLE patients, compared to the general population.

Objective Cognitive function may change over time in patients with systemic lupus erythematosus (SLE), and cognitive function trajectories have not been well studied. We aimed to identify cognitive function trajectories in SLE and describe them with depressive symptoms trajectories, and we also aimed to identify baseline factors associated with class membership in the dual trajectories. Methods Longitudinal data from the University of California San Francisco Lupus Outcomes Study were analyzed. Two outcome trajectories were studied jointly, the Hopkins Verbal Learning Test–Revised and the Center for Epidemiologic Studies Depression Scale (CES‐D) (administered annually). Univariate/multivariable logistic regression analyses examined baseline factors associated with class memberships. Results A total of 755 patients were studied, and 4 latent classes were identified: 1) low CES‐D scores and low cognitive scores (no depression plus cognitive impairment; 20%), 2) lowest CES‐D scores and highest normal cognitive scores (no depression plus normal cognition; 48%), 3) highest CES‐D scores and lowest cognitive scores (depression plus cognitive impairment; 9%), and 4) high CES‐D scores and cognitive score at borderline (depression plus borderline cognition; 23%). Conclusion In all, 4 distinct classes of dual cognitive function and depressive symptoms were identified. Persistently low cognitive performance in 28% of patients (classes 1 and 3) did not significantly improve over 7 years. Cognitive impairment was associated with depression status in 9% of patients (class 3). Other factors also predicted latent class membership: ethnicity, education, disease activity, physical functioning, and bodily pain. These results highlight the importance of periodic assessment of cognitive function and of different aspects relevant for assessing and managing cognitive function over time in SLE.

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