Understanding the epidemiology and progression of systemic lupus erythematosus

Abstract

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.

Figure 1

A model of the factors affecting the course and outcome of SLE (modified from (5)).

Figure 2

Age-specific incidence rates for SLE in females, from 2 studies from the United States with data for African Americans and whites. (A) is from Hochberg (43) and (B) is from McCarty and coworkers (7). (Color version of figure is available online.)

Figure 3

Age-specific incidence rates for SLE in females in the United Kingdom (20) (calculated by interpolation from graph), Sweden (12), and Iceland (21). (Color version of figure is available online.)