Systemic lupus erythematosus
Understanding the Epidemiology and Progression of Systemic Lupus Erythematosus

https://doi.org/10.1016/j.semarthrit.2008.10.007Get rights and content

Objectives

This review examines the burden and patterns of disease in systemic lupus erythematosus (SLE) and the influence and interactions of gender, ethnicity, age, and psychosocial attributes with respect to disease progression, focusing on issues relevant to clinical practice and research.

Methods

PubMed literature search complemented by review of bibliographies listed in identified articles.

Results

An increased risk among reproductive age women is clearly seen in African Americans in the United States. However, in other populations, a different pattern is generally seen, with the highest age-specific incidence rates occurring in women after age 40 years. The disease is 2 to 4 times more frequent, and more severe, among nonwhite populations around the world and tends to be more severe in men and in pediatric and late-onset lupus. SLE patients now experience a higher than 90% survival rate at 5 years. The less favorable survival experience of ethnic minorities is possibly related to socioeconomic status rather than to ethnicity per se, and adequate social support has been shown to be a protective factor, in general, in SLE patients. Discordance between physician and patient ratings of disease activity may affect quality of care.

Conclusions

Our understanding of ways to improve outcomes in SLE patients could benefit from patient-oriented research focusing on many dimensions of disease burden. Promising research initiatives include the inclusion of community-based patients in longitudinal studies, use of self-assessment tools for rating disease damage and activity, and a focus on self-perceived disease activity and treatment compliance.

Section snippets

Methods

This review is based on publications found through searches of the MEDLINE database for relevant articles using the combination search terms of lupus and (epidemiology, incidence, prevalence, mortality, gender, ethnicity, damage, quality of life). References within these selected reports were also reviewed. We included epidemiological studies of incidence or prevalence that spanned the years 1975 to 2000, and mortality studies of cohorts assembled in 1975 or later. The mortality studies were

Incidence and Prevalence of SLE Around the World

Incidence rates of SLE range from approximately 1 to 10 per 100,000 person-years (Table 1) (6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24) and prevalence rates generally range from 20 to 70 per 100,000 (Table 2) (6, 8, 9, 10, 12, 13, 14, 15, 16, 17, 18, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35). In reviewing the available studies, it is important to note that epidemiological studies of SLE may differ by sampling and recruitment methodologies used. The

Discussion

We have reviewed the published literature related to the incidence and prevalence rates of SLE as well as the factors affecting the expression and the intermediate and long-term outcomes of the disease, including mortality risk, organ damage, and health-related quality of life. The disease is overall more frequent among minority population groups around the world and the outcome of the disease is less favorable in these populations. The role of socioeconomic factors in the course and outcome of

Acknowledgments

This article is based on presentations and discussions that took place during the workshop on “Lupus and the Environment: Disease Development, Progression and Flare,” which was held in Washington, DC, September, 2005. The concept for this focused workshop was produced by the Federal Interagency Working Group on Women's Health and the Environment and support was provided by the U.S. Department of Health and Human Services' Office of Women's Health, The National Institute of Environmental Health

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