Systematic review of the epidemiology of systemic lupus erythematosus in the Asia‐Pacific region: Prevalence, incidence, clinical features, and mortality

Abstract

Objective. Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease with a wide spectrum of manifestations, shows considerable variation across the globe, although there is little evidence to indicate its relative prevalence in Asia. This review describes its prevalence, severity, and outcome across countries in the Asia-Pacific region. Methods. We conducted a systematic literature search using 3 groups of terms (SLE, epidemiology, and Asia-Pacific countries) of EMBase and PubMed databases and non-English language resources, including Chinese Wanfang, Korean KMbase, Korean College of Rheumatology, Japana Centra Revuo Medicina, Taiwan National Digital Library of Theses and Dissertations, and Taiwanese, Thai, and Vietnamese journals. Results. The review showed considerable variation in SLE burden and survival rates across Asia-Pacific countries. Overall crude incidence rates (per 100,000 per year) ranged from 0.9 -3.1, while crude prevalence rates ranged from 4.3-45.3 (per 100,000). Higher rates of renal involvement, one of the main systems involved at death, were observed for Asians (21-65% at diagnosis and 40 -82% over time) than for whites. While infections and active SLE were leading causes of death, a substantial proportion (6 -40%) of deaths was due to cardiovascular involvement. The correlation between the Human Development Index and 5-year survival was 0.83. Conclusion. This review highlights the need to closely monitor Asian SLE patients in Asian countries for renal and cardiovascular involvement, especially those who may not receive proper treatment and are therefore at greater risk of severe disease. We hope this will encourage further research specific to this region and lead to improved clinical management.

Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease

“…3 Studies have also demonstrated that the prognosis of SLE is worse in nonwhite persons, in whom there is a younger age at onset of their disease, as well as a higher frequency of severe renal disease. [1][2][3][4][5] These observations may be due to 'protective factors' associated with European ancestry or may indicate the presence of specific risk factors associated with other ethnic groups. Based on these aforementioned findings, it may be argued that persons of non-European ancestry diagnosed with SLE should be more closely monitored.…”

“…Based on these aforementioned findings, it may be argued that persons of non-European ancestry diagnosed with SLE should be more closely monitored. 4,5 Caution should be excised with this approach given that all affected individuals do still have the risk of developing severe complications of their disease. There are other phenotypic characteristics that may vary in relation to ethnicity.…”

Oral Mucosal Lesions as Initial Presentation in Lupus Erythematosus Patient (A Case Report)

“…LE suffered more by women than men especially during reproductive period Advances in Health Science Research, volume 8 [12]. Life expectancy increased over the last 5 years in Asia Pacific countries, 60% Australia, 94% South Korea, 97% Hong Kong, 98% China (Shanghai), whereas in the last 10 years 70% of Malaysia, and 94% of Hongkong [15]. High mortality rates in men versus women due to cardiovascular disorders resulting from the habit of smoking [12].…”

Introduction and Physiology of Lupus

“…Many studies (epidemiological) have found that Caucasians have a twofold to threefold lower incidence and prevalence rates than Asians [72][73][74][75][76][77][78][79]. Moreover, it was found in many studies that Asians had more severe symptoms and signs of the disease, more aggressive kidney involvements, and the autoantibody positivity was also higher in Asians than in non-Asians [76,[79][80][81][82][83].…”