Morbidity and Mortality in Systemic Lupus Erythematosus During a 5-Year Period: A Multicenter Prospective Study of 1,000 Patients

Abstract

In the present study we assessed the frequency and characteristics of the main causes of morbidity and mortality in SLE during a 5-year period and analyzed the prognostic significance for morbidity and mortality of the main immunologic parameters used in clinical practice. We started in 1990 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 5 years (1990-1995). Four hundred thirteen patients (41.3%) presented 1 or more episodes of arthritis, 264 (26.4%) had malar rash, 222 (22.2%) active nephropathy, 139 (13.9%) fever, 136 (13.6%) neurologic involvement, 132 (13.2%) Raynaud phenomenon, 129 (12.9%) serositis (pleuritis and/or pericarditis), 95 (9.5%) thrombocytopenia, and 72 (7.2%) thrombosis. Two hundred seventy patients (27%) presented infections, 113 (11.3%) hypertension, 75 (7.5%) osteoporosis, and 59 (5.9%) cytopenia due to immunosuppressive agents. Sixteen patients (1.6%) developed malignancies, with the most frequent primary localizations the uterus and the breast. Several immunologic parameters (anti-dsDNA or antiphospholipid antibodies) were found to have a predictive value for the development of SLE manifestations during the period of the study. Forty-five patients (4.5%) died; the most frequent causes of death were divided similarly among active SLE (28.9%), infections (28.9%), and thromboses (26.7%). A survival probability of 95% at 5 years was found. A lower survival probability (92%) was detected in those patients who presented at the beginning of the study with nephropathy.

Renin–angiotensin system gene polymorphisms predict the progression to renal insufficiency among Asians with lupus nephritis

“…1 Both SLE and end-stage renal disease (ESRD) show clear familial patterns, suggesting a significant genetic component to disease development and/or progression. [2][3][4] There is also evidence based on both animal models and humans implicating a set of LN and end organ damage susceptibility genes distinct from those that influence general SLE susceptibility.…”

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXV. Smoking, older age, disease activity, lupus anticoagulant, and glucocorticoid dose as risk factors for the occurrence of venous thrombosis in lupus patients

“…Venous thrombosis is a relatively common manifestation and/or complication occurring in patients with systemic lupus erythematosus (SLE), being reported in ϳ10% of patients (1,2). Venous thrombosis may lead to life-threatening complications such as pulmonary thromboembolism and pulmonary hypertension or to residual damage such as venous stasis with chronic edema and ulcerations of the lower limbs.…”

“…Venous thrombosis may lead to life-threatening complications such as pulmonary thromboembolism and pulmonary hypertension or to residual damage such as venous stasis with chronic edema and ulcerations of the lower limbs. Furthermore, proportionate mortality in SLE resulting from thrombotic events (arterial and venous together) has been estimated to be ϳ27% (1). The association of venous thrombosis with antiphospholipid antibodies (aPL) (IgG and IgM anticardiolipin antibodies and lupus anticoagulant [LAC]) has been well established; this has been observed in patients without an underlying autoimmune disease (3), but has particularly been found in patients with SLE (4).…”

The problems and pitfalls in systemic lupus erythematosus drug discovery

“…Actually, the dissimilar incidences of clinical manifestations included in disease activity scores influence unequally the outcome. [9,10] Furthermore, since SLE is a multiorgan disease, probably different pathophysiologic pathways lead to each clinical manifestation and, as expected, the experimental drug might have different effect on each domain. Thus, sometimes it becomes hard to understand the real effect of a given drug based on score results.…”