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Dedicated to increasing awareness about
systemic lupus erythematosus (SLE), disease activity and related organ damage

Organ Damage
and Patient Burden

The course of SLE can vary greatly from patient to patient.1 Organ damage is one of the most important correlates with morbidity and mortality.2 It begins to accrue early with 33% to 50% of patients showing evidence of damage in the first 5 years following diagnosis.3,4

Early organ damage is associated with a reduced 10-year survival rate.5 Once organ damage occurs, the risk of additional damage and mortality are greatly increased.4

Patients still accrue organ damage even with low/moderate disease activity. Multiple factors may contribute to damage accrual, including the chronic use of corticosteroids.6

Several organ systems are commonly involved in SLE and should be carefully monitored for disease activity. They include the central nervous system, kidneys, gastrointestinal system, mucous membranes, heart, skin, hematologic system, musculoskeletal system, and lungs.1,6,7

Severity of the disease can vary from mild to potentially fatal, due to detrimental organ damage.2

Learn more about the organ systems commonly involved.

Mucocutaneous involvement is almost universal in SLE. Manifestations include8:

  • rashes
  • photosensitivity
  • nasal and oral ulcers
  • alopecia

A dermatologist consultation may be useful for a second opinion, further evaluation, or possible biopsy. A dermatologist may also be considered if serologic testing is positive for Sjögren's syndrome A (SSA) and Sjögren's syndrome B (SSB) antibodies, as they can be associated with subacute cutaneous lupus.9

Skin manifestations are seen in nearly 80% of patients with lupus.9 Watch this webcast for a dermatologist perspective of SLE.

Monitoring for SLE includes skin manifestations. Learn more now

Neuropsychiatric syndromes affect up to 80% of patients with SLE.10

They range from mild to severe. The most common manifestations include1,11,12:

  • cognitive dysfunction
  • headache
  • depression
  • anxiety

It may be beneficial to refer some patients for formal neuropsychiatric testing.

Cognitive testing may be performed by a neurologist or psychologist, along with laboratory tests and, in some cases, magnetic resonance imaging (MRI).

Up to 80% of patients with SLE have cognitive impairment.10 Watch this webcast for more information on assessment of neurologic manifestations of SLE.

Monitoring for SLE includes cognitive impairment. Learn more now

SLE may affect almost any part of the eye and the visual pathway.13 If a patient has ophthalmic issues, he or she should be referred to an ophthalmologist.

Encourage patients to report the following symptoms, which may be a sign of potential complications13:

  • blurriness
  • dry eyes
  • loss of vision
  • pain

Watch this webcast for more information on assessment of ophthalmic manifestations of SLE.

Did you know?

2 in 10 patients with SLE experience eye disease1

Monitoring for SLE includes eye disease. Learn more now

Risks of coronary heart disease and stroke are significantly higher for patients with SLE compared to general population. Patients with SLE are at 2 to 10 times increased risk of CHD and 6 to 8 times increased risk of stroke.15,22

There is increased risk of coronary artery disease in patients with SLE that cannot be explained by traditional Framingham risk factors.14 Patients 35 to 44 years of age have the greatest risk for cardiovascular manifestations. Compared with age-matched controls, they are 50 times more likely to experience myocardial infarction.16 Hospitalization rates for acute myocardial infarction are 2.3 times higher than that of the general population.17

Pericarditis is the most common cardiac condition experienced by patients with SLE.1 A cardiologist can perform additional assessments, if necessary, including an electrocardiogram, an echocardiogram, functional studies, and cardiac catheterization.17 It's important to work with a cardiologist who has experience treating patients with SLE.

Watch this webcast for more information on assessment of cardiac manifestations of SLE.

Did you know?

SLE patients are over 2.5 times more likely to experience a cardiovascular event22

Monitoring for SLE includes cardiovascular health. Learn more now

Renal damage is one of the most serious complications of systemic lupus erythematosus.1 Urinalysis abnormalities or renal dysfunction exist in 35% of patients early in the course of the disease.18 Up to 60% of adults with SLE develop renal abnormalities over the course of their disease.18

Lupus nephritis has higher prevalence in African-Americans and Hispanics than in Caucasians.18 The incidence is also higher in men than in women.19

If the patient has an abnormal urinalysis with any findings such as proteinuria, casts or hematuria, there should be consideration for a nephrology referral.

Up to 60% of adults develop renal damage during the course of the disease.18 Watch this webcast for more information on assessment of renal manifestations of SLE.

Monitoring for SLE includes kidney disease. Learn more now

Patients with SLE are 5 times more likely to have a bone fracture than age-matched controls.20 This is primarily due to the use of steroids in their treatment. The relative risk of osteoporotic fractures is increased 1.9 fold with a cumulative dose of 36.5 g of corticosteroids.21

Did you know?

18 to 24 year-olds with SLE are 12x more likely to have bone fracture compared to the general population20

In addition, osteonecrosis occurs in as many as 44% of patients with SLE.8

Monitoring for SLE includes bone health. Learn more now

SYSTEMIC LUPUS ERYTHEMATOSUS
(SLE): FOCUS ON
ORGAN DAMAGE

A flipchart featuring an overview of SLE and the damage it may cause
to organ systems.

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CLINICAL IMPACT OF SYSTEMIC LUPUS ERYTHEMATOSUS DISEASE ACTIVITY ON LONG-TERM ORGAN DAMAGE

R. Elaine Lambert, MD, in a question and answer format.

This promotional program was developed in conjunction with and sponsored by GSK, based on an interview with R. Elaine Lambert, MD.

Dr. Lambert received a fee for participation in this program.

View Now (PDF)

What Next?

Contributing factors to organ damage can include persistent disease activity and drug-related side effects.23,24

Learn more now

References:
1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health and Human Services. Lupus: A Patient Care Guide for Nurses and Other Health Professionals. 3rd ed. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases; 2006. NIH publication 06-4262. http://www.niams.nih.gov/health_info/lupus/lupus_ff.pdf. Accessed February 14, 2017. 2. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis Rheum. 1999;42(9):1785-1796. http://www.ncbi.nlm.nih.gov/pubmed/10513791. Accessed February 14, 2017. 3. Chambers SA, Allen E, Rahman A, Isenberg D. Damage and mortality in a group of British patients with systemic lupus erythematosus followed up for over 10 years. Rheumatology (Oxford). 2009;48(6):673-675. http://dx.doi.org/10.1093/rheumatology/kep062. Accessed February 14, 2017. 4. Urowitz MB, Gladman DD, Ibañez D, et al. Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort. Arthritis Care Res (Hoboken). 2012;64(1):132-137. http://dx.doi.org/10.1002/acr.20648. Accessed February 14, 2017. 5. Rahman P, Gladman DD, Urowitz MB, Hallett D, Tam LS. Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus. Lupus. 2001;10(2):93-96. http://www.ncbi.nlm.nih.gov/pubmed/11237132. Accessed February 14, 2017. 6. Lopez R, Davidson JE, Beeby MD, et al. Lupus disease activity and the risk of subsequent organ damage and mortality in a large lupus cohort. Rheumatology (Oxford). 2012;51(3):491-498. http://dx.doi.org/10.1093/rheumatology/ker368. Accessed February 14, 2017. 7. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health and Human Services. What Is Lupus? Fast Facts: An Easy-to-Read Series of Publications for the Public. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases; 2009. 8. Bertsias G, Cervera R, Boumpas DT. Systemic lupus erythematosus: pathogenesis and clinical features. In: EULAR Textbook on Rheumatic Diseases. Geneva, Switzerland: European League Against Rheumatism. 2012:476-505. http://www.eular.org/myUploadData/files/sample%20
chapter20_mod%2017.pdf. Accessed February 14, 2017. 9. Kuhn A, Sticherling M, Bonsmann G. Clinical manifestations of cutaneous lupus erythematosus. J Dtsch Dermatol Ges. 2007;5(12):1124-1137. http://dx.doi.org/10.1111/j.1610-0387.2007.06554.x. Accessed February 14, 2017. 10. Brey RL, Holliday SL, Saklad AR, et al. Neuropsychiatric syndromes in lupus: Prevalence using standardized definitions. Neurology. 2002;58:1214–1220. http://www.ncbi.nlm.nih.gov/pubmed/11971089. Accessed February 14, 2017. 11. Stockl A. Complex syndromes, ambivalent diagnosis, and existential uncertainty: The case of systemic lupus erythematosus (SLE). Soc Sci Med. 2007;65(7):1549-1559. http://dx.doi.org/10.1016/j.socscimed.2007.05.016. Accessed February 14, 2017. 12. Kim SJ, Persad P, Erkan D, et al. Research studies and their implications for social work practice in a multidisciplinary center for lupus care. Soc Work Health Care. 2012;51(7):652-660. http://dx.doi.org/10.1080/00981389.2012.683711. Accessed February 14, 2017. 13. Sivaraj RR, Durrani OM, Denniston AK, Murray PI, Gordon C. Ocular manifestations of systemic lupus erythematosus. Rheumatology (Oxford). 2007;46(12):1757-1762. http://dx.doi.org/10.1093/rheumatology/kem173. Accessed February 14, 2017. 14. Manzi S, Meilahn EN, Rairie JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol. 1997;145(5):408-415. http://aje.oxfordjournals.org/content/145/5/408.long. Accessed February 14, 2017. 15. Schoenfield S, Kasturi S, Costenbader K. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Seminars Arthritis Rheum. 2013;43:77-95. http://dx.doi.org/10.1016/j.semarthrit.2012.12.002. Accessed February 14, 2017. 16. Petri M. Monitoring systemic lupus erythematosus in standard clinical care. Best Pract. Res. Clin. Rheumatol. 2007;21(4):687-697. http://dx.doi.org/10.1016/j.berh.2007.01.003. Accessed February 14, 2017. 17. Ward MM. Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythematosus. Arthritis Rheum. 1999;42(2):338-346. http://dx.doi.org/10.1002/1529-0131(199902)42:2%3C338::AID-ANR17%3E3.0.CO;2-U. Accessed February 14, 2017. 18. Hahn BH, McMahon MA, Wilkinson A, et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64(6):797-808. http://dx.doi.org/10.1002/acr.21664. Accessed February 14, 2017. 19. Andrade RM, Alarcón GS, Fernández M, et al. Accelerated damage accrual among men with systemic lupus erythematosus: XLIV. Results from a multiethnic US cohort. Arthritis Rheum. 2007;56(2):622-630. http://dx.doi.org/10.1002/art.22375. Accessed February 14, 2017. 20. Ramsey-Goldman R, Dunn JE, Huang CF, Dunlop D, Rairie JE, Fitzgerald S, et al. Frequency of fractures in women with systemic lupus erythematosus: comparison with United States population data. Arthritis Rheum. 1999;42:882–90. http://dx.doi.org/10.1002/1529-0131(199905)42:5%3C882::AID-ANR6%3E3.0.CO;2-C. Accessed February 14, 2017. 21. Zonana-Nacach A, Barr SG, Magder LS, Petri M. Damage in systemic lupus erythematosus and its association with corticosteroids. Arthritis Rheum. 2000;43(8):1801-8. http://dx.doi.org/10.1002/1529-0131(200008)43:8%3C1801::AID-ANR16%3E3.0.CO;2-O. Accessed February 14, 2017. 22. Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol. 2012;176(8):708-719. http://dx.doi.org/10.1093/aje/kws130. Accessed February 14, 2017. 23. Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the systemic lupus international collaborating clinics/American college of rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363-369. http://dx.doi.org/10.1002/art.1780390303. Accessed February 14, 2017. 24. Doria A. et al. Optimizing outcome in SLE: treating-to-target and definition of treatment goals. Autoimmun Rev. 2014;13(7):770-7. http://dx.doi.org/10.1016/j.autrev.2014.01.055. Accessed February 14, 2017.