How to improve morbidity and mortality in systemic lupus erythematosus

Extract

Systemic Lupus Erythematosus/Series Editors: D. Isenberg and C. Gordon

Evolving spectrum of clinical presentation in systemic lupus erythematosus (SLE)

SLE is a chronic multisystem disorder of presumed autoimmune origin in which cytotoxic antibodies, or circulating immune complexes, give rise to tissue damage often resulting in end organ disease and even mortality. The first large series to study mortality in this disease in 1955 revealed a survival of less than 50% at 5 yr [1]. Thus, in the past four decades much of the therapeutic initiatives in this disease have been directed at controlling the acute organ attack and inflammatory response in order to minimize tissue damage and to decrease the very high mortality rates. The therapeutic interventions have focused on the use of corticosteroids and cytotoxic agents in appropriate doses to minimize mortality on the one hand and morbidity from the disease or from the treatments on the other. This approach has in fact been quite successful and the overall mortality rates have improved dramatically over this period of time [2, 3] (Table 1). The reported 20‐yr survival of 68% [22] in the 1990s in contrast to the 50% 5‐yr survival in 1955 indicates success in controlling the acute immunological injury typical of this condition. Furthermore, we have shown that this improved survival was greater than the improvement in survival observed in the general population during the same time. The standardized mortality ratios for SLE patients improved from 10.1 in the 1970s, to 4.8 in the early 1980s, and to 3.3 in the early 1990s [27].