The reply

Abstract

All adult patients with systemic lupus erythematosus (SLE) (greater than or equal to 15 years old, n = 86) from a defined population (approximately 160,000 population at risk) were followed prospectively over 6 years. The study area comprised 2 health care districts served by only 1 hospital. Retrieval was based on clinical case finding and computerized diagnosis and laboratory registers. The incidence of the disease was 4.0 cases/100,000 adults/year and was stable during the 6 years, suggesting that completeness of retrieval was high. Point prevalence by the end of 1986 was 42 cases/100,000 population at risk and 5-year survival in the prospective group 97%. Immunologically the group was characterized by a high frequency of positive anti-dsDNA (73%), and a low frequency of rheumatoid factor positivity (10%). The frequency of ARA criteria (median, 6) was comparable with previous larger series of selected patients. Sixteen percent of the patients were males, and they had more serositis and renal manifestations than females. In view of the low mortality we studied the more sensitive outcome measures: disease activity, irreversible organ damage, and functional impairment. After the diagnosis year, disease flares occurred with a constant frequency of 0.2 flares/year/patient, even after long duration of disease. Patients with neuropsychiatric disease, history of drug reactions, and immunological abnormalities such as persistent hypocomplementemia, antibodies to dsDNA, and cardiolipin had a high frequency of relapse. In contrast, elderly patients with serositis during their first flare seldom relapsed. The number of gainfully employed individuals was normal. Neuropsychiatric disease and joint involvement were principal causes of long-standing functional impairment. Notably, patients with renal disease usually fared well, as reflected by preserved renal function and little functional by preserved renal function and little functional impairment. Disease duration and glucocorticoid treatment were major denominators for morbidity due to infections and vascular disease with the incidence of myocardial infarctions being 9 times more common than that in a Swedish control population. Prolonged glucocorticoid treatment was also related to mortality, which was predominantly due to cardiovascular or central nervous system disease. The present prospective and epidemiologically based study of outcome in SLE was made possible by a uniquely coordinated health care system, enabling complete identification of the patients within the study area.(ABSTRACT TRUNCATED AT 400 WORDS)

Predictors of the first cardiovascular event in patients with systemic lupus erythematosus - a prospective cohort study

“…Arthritis and pleuritis are SLE manifestations, often associated with a more pronounced acute phase response [15,44], and patients with these symptoms had a higher risk of developing a first CVE, as also reported by Mok et al [16]. Patients with a previous episode of venous occlusion, a major manifestation of APS [43], were more likely to present with a first CVE.…”

“…However, other studies have shown that patients with SLE have a marked increased risk of CVD as compared to the general population [2,15,50]. …”

“…Prospective studies that evaluate both traditional and lupus associated risk factors for hard endpoints, that is, CVEs, are to date relatively few in SLE [8,15,16] and outnumbered by studies focused on subclinical atherosclerosis in these patients [4,17,18]. But, measurements of atherosclerosis are surrogate markers of CVD and given the complexity of SLE, accelerated atherosclerosis may not be the only biologically plausible connection to CVEs.…”

Cardiovascular Comorbidity in Rheumatic Diseases

“…101,102 The increased relative risk is especially striking in young women, with a prospective cohort study estimating that women in the 35- to 44-year-old age group were more than 50 times more likely to have an MI compared with women of a similar age. 102 …”

Platelet Activation and Anti-Phospholipid Antibodies Collaborate in the Activation of the Complement System on Platelets in Systemic Lupus Erythematosus

“…SLE patients have a highly increased cardiovascular morbidity and mortality which can only be partly explained by traditional risk factors [2], [3], [4], [5]. Anti-phospholipid (aPL) antibodies are a group of phospholipid-binding autoantibodies with overlapping, but partly different specificities.…”