Surviving the butterfly and the wolf: Mortality trends in systemic lupus erythematosus

Andrea T. Borchers, Carl L Keen, Yehuda Shoenfeld, M. Eric Gershwin

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Objective: To address changes in survival of patients with systemic lupus erythematosus (SLE) and to compare mortality statistics with associated disease specific as well as comorbid conditions. Methods: Review of the international literature on survival of patients with SLE. Results: During the first half of the 20th century, SLE was considered a rapidly progressive and almost invariably fatal disease. Since the 1950s, the estimated 5-year survival of SLE patients in developed countries rose from <50% to >95% and similar increases were seen in 10-year survival. Mortality rates of SLE patients, however, remain ∼3 times that of an age- and sex-matched population in most studies, indicating that death still occurs prematurely in a substantial portion of patients, albeit later in the disease course. This improved prognosis does not appear to have been shared equally by all racial/ethnic groups. This appears to be attributable more to socioeconomic and sociocultural factors than to true differences in disease manifestations. Along with the increased survival of SLE patients, there has been a change in the causes of death. Most notably, there has been a dramatic increase in the proportionate mortality from vascular disease, particularly accelerated atherosclerosis. Both disease and therapeutic modalities, in particular corticosteroids, appear to contribute to the high prevalence of coronary artery disease (CAD). Conclusions: Much progress has been made in improving the survival of SLE, but there is need for further improvement. Aggressive treatment of risk factors for CAD is advisable, but it remains to be assessed to what extent such interventions can further reduce mortality.

Original languageEnglish (US)
Pages (from-to)423-453
Number of pages31
JournalAutoimmunity Reviews
Volume3
Issue number6
DOIs
StatePublished - Aug 2004

Fingerprint

Butterflies
Systemic Lupus Erythematosus
Mortality
Survival
Coronary Artery Disease
Vascular Diseases
Ethnic Groups
Developed Countries
Cause of Death
Atherosclerosis
Adrenal Cortex Hormones
Therapeutics
Population

Keywords

  • Accelerated atherosclerosis
  • Comorbidity
  • Immunosuppressive agents
  • Racial/ethnic epidemiology
  • Steroids
  • Survival
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Surviving the butterfly and the wolf : Mortality trends in systemic lupus erythematosus. / Borchers, Andrea T.; Keen, Carl L; Shoenfeld, Yehuda; Gershwin, M. Eric.

In: Autoimmunity Reviews, Vol. 3, No. 6, 08.2004, p. 423-453.

Research output: Contribution to journalArticle

Borchers, Andrea T. ; Keen, Carl L ; Shoenfeld, Yehuda ; Gershwin, M. Eric. / Surviving the butterfly and the wolf : Mortality trends in systemic lupus erythematosus. In: Autoimmunity Reviews. 2004 ; Vol. 3, No. 6. pp. 423-453.
@article{1b541e19dd6c492984110313e96c58f3,
title = "Surviving the butterfly and the wolf: Mortality trends in systemic lupus erythematosus",
abstract = "Objective: To address changes in survival of patients with systemic lupus erythematosus (SLE) and to compare mortality statistics with associated disease specific as well as comorbid conditions. Methods: Review of the international literature on survival of patients with SLE. Results: During the first half of the 20th century, SLE was considered a rapidly progressive and almost invariably fatal disease. Since the 1950s, the estimated 5-year survival of SLE patients in developed countries rose from <50{\%} to >95{\%} and similar increases were seen in 10-year survival. Mortality rates of SLE patients, however, remain ∼3 times that of an age- and sex-matched population in most studies, indicating that death still occurs prematurely in a substantial portion of patients, albeit later in the disease course. This improved prognosis does not appear to have been shared equally by all racial/ethnic groups. This appears to be attributable more to socioeconomic and sociocultural factors than to true differences in disease manifestations. Along with the increased survival of SLE patients, there has been a change in the causes of death. Most notably, there has been a dramatic increase in the proportionate mortality from vascular disease, particularly accelerated atherosclerosis. Both disease and therapeutic modalities, in particular corticosteroids, appear to contribute to the high prevalence of coronary artery disease (CAD). Conclusions: Much progress has been made in improving the survival of SLE, but there is need for further improvement. Aggressive treatment of risk factors for CAD is advisable, but it remains to be assessed to what extent such interventions can further reduce mortality.",
keywords = "Accelerated atherosclerosis, Comorbidity, Immunosuppressive agents, Racial/ethnic epidemiology, Steroids, Survival, Systemic lupus erythematosus",
author = "Borchers, {Andrea T.} and Keen, {Carl L} and Yehuda Shoenfeld and Gershwin, {M. Eric}",
year = "2004",
month = "8",
doi = "10.1016/j.autrev.2004.04.002",
language = "English (US)",
volume = "3",
pages = "423--453",
journal = "Autoimmunity Reviews",
issn = "1568-9972",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Surviving the butterfly and the wolf

T2 - Mortality trends in systemic lupus erythematosus

AU - Borchers, Andrea T.

AU - Keen, Carl L

AU - Shoenfeld, Yehuda

AU - Gershwin, M. Eric

PY - 2004/8

Y1 - 2004/8

N2 - Objective: To address changes in survival of patients with systemic lupus erythematosus (SLE) and to compare mortality statistics with associated disease specific as well as comorbid conditions. Methods: Review of the international literature on survival of patients with SLE. Results: During the first half of the 20th century, SLE was considered a rapidly progressive and almost invariably fatal disease. Since the 1950s, the estimated 5-year survival of SLE patients in developed countries rose from <50% to >95% and similar increases were seen in 10-year survival. Mortality rates of SLE patients, however, remain ∼3 times that of an age- and sex-matched population in most studies, indicating that death still occurs prematurely in a substantial portion of patients, albeit later in the disease course. This improved prognosis does not appear to have been shared equally by all racial/ethnic groups. This appears to be attributable more to socioeconomic and sociocultural factors than to true differences in disease manifestations. Along with the increased survival of SLE patients, there has been a change in the causes of death. Most notably, there has been a dramatic increase in the proportionate mortality from vascular disease, particularly accelerated atherosclerosis. Both disease and therapeutic modalities, in particular corticosteroids, appear to contribute to the high prevalence of coronary artery disease (CAD). Conclusions: Much progress has been made in improving the survival of SLE, but there is need for further improvement. Aggressive treatment of risk factors for CAD is advisable, but it remains to be assessed to what extent such interventions can further reduce mortality.

AB - Objective: To address changes in survival of patients with systemic lupus erythematosus (SLE) and to compare mortality statistics with associated disease specific as well as comorbid conditions. Methods: Review of the international literature on survival of patients with SLE. Results: During the first half of the 20th century, SLE was considered a rapidly progressive and almost invariably fatal disease. Since the 1950s, the estimated 5-year survival of SLE patients in developed countries rose from <50% to >95% and similar increases were seen in 10-year survival. Mortality rates of SLE patients, however, remain ∼3 times that of an age- and sex-matched population in most studies, indicating that death still occurs prematurely in a substantial portion of patients, albeit later in the disease course. This improved prognosis does not appear to have been shared equally by all racial/ethnic groups. This appears to be attributable more to socioeconomic and sociocultural factors than to true differences in disease manifestations. Along with the increased survival of SLE patients, there has been a change in the causes of death. Most notably, there has been a dramatic increase in the proportionate mortality from vascular disease, particularly accelerated atherosclerosis. Both disease and therapeutic modalities, in particular corticosteroids, appear to contribute to the high prevalence of coronary artery disease (CAD). Conclusions: Much progress has been made in improving the survival of SLE, but there is need for further improvement. Aggressive treatment of risk factors for CAD is advisable, but it remains to be assessed to what extent such interventions can further reduce mortality.

KW - Accelerated atherosclerosis

KW - Comorbidity

KW - Immunosuppressive agents

KW - Racial/ethnic epidemiology

KW - Steroids

KW - Survival

KW - Systemic lupus erythematosus

UR - http://www.scopus.com/inward/record.url?scp=4444291079&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4444291079&partnerID=8YFLogxK

U2 - 10.1016/j.autrev.2004.04.002

DO - 10.1016/j.autrev.2004.04.002

M3 - Article

C2 - 15351310

AN - SCOPUS:4444291079

VL - 3

SP - 423

EP - 453

JO - Autoimmunity Reviews

JF - Autoimmunity Reviews

SN - 1568-9972

IS - 6

ER -