CHARLESTON, South Carolina—Despite some advances in treatment, recently diagnosed systemic lupus erythematosus (SLE) patients still face elevated risks of death within 5 years of their diagnosis when compared with lupus-free controls, according to a study in the April 15, 2008 issue of Arthritis Care & Research.¹

"The severity and heterogeneity of SLE at diagnosis and its unpredictable course highlight the need for less toxic and more effective treatments," conclude researchers led by Robert Campbell, Jr, PhD, of the Medical University of South Carolina in Charleston.

The researchers evaluated 5-year mortality risk and predictors of mortality among 265 recently diagnosed SLE patients and 355 SLE-free controls. The median time since diagnosis was 13 months. They also assessed quality of life using an 8-item quality of life instrument derived from the standard 36-item Medical Outcomes Study short form 36.

The 5-year mortality risk was 9.7% among SLE cases, compared with 0.3% of the control patients (P <.0001). Causes of death included renal failure, intracerebral hemorrhage cerebrovascular disease, sepsis, cardiorespiratory arrest, and pulmonary embolism. The predominant cause of death was cardiovascular disease, which contributed to 41% of the deaths seen among SLE patients, the study showed. Infection was the second leading cause of death, contributing to 19% of deaths among SLE patients.

Mortality risk was highest among older patients, men, African Americans, patients with lupus nephritis, and patients with anti-double–stranded (ds) DNA antibodies. Specifically those patients with lupus nephritis and those who tested positive for anti-dsDNA antibodies at enrollment had a 2.5 fold increase risk of death. "Our study also adds to the available research on mortality risks of SLE by providing additional evidence that males have higher 5-year mortality rates compared with females and that the presence of anti-dsDNA antibodies and lupus nephritis are also associated with increased mortality," the researchers write.

In addition, the 21 patients who did not provide a blood sample at study enrollment experienced increased mortality risk. This association has not been seen before, the study authors note. Physical component scores of the quality of life measure were 7.7 points lower and mental component scores were 1.8 points lower in lupus patients compared with controls.

"Additional research is needed to better understand the contributions to the impact on the deceased physical domain and summary scores in patients with SLE, in contrast to the relative stability of the mental component scores among patients and controls."

Reference

1. Campbell R Jr, Cooper GS, Gilkeson GS. Two aspects of the clinical and humanistic burden of systemic lupus erythematosus: mortality risk and quality of life early in the course of the disease. Arthritis Care Res. 2008;59:458-464.