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

SLE and Disease Activity

Symptoms of SLE are diverse, with inflammation affecting a wide variety of organ systems.1,2 The course of the disease varies from patient to patient. There are periods of disease inactivity followed by flares (waxing and waning disease).1

Younger patients (16-24) with SLE have much higher rates of mortality compared to their age cohort in the general population.3

Persistent disease activity is linked to increased organ damage, which in turn is predictive of increased damage and mortality. Causes of death vary, but majority of deaths are due to CV events, infections or cancer.4

There are long-term consequences for patients with persistent disease activity:

  • Possible predictor of flares, which impacts morbidity and mortality5,6
  • Lower probability of remission6,7
  • Higher use of glucocorticoids8,9

Control of disease activity in patients is thought to be important in reducing permanent organ damage and is likely to impact on the outcome of the patient.10

Click on the patient hot spots below for more information on the various organ systems that may be affected by SLE.

brain
eyes
muscles and bones
heart
skin
kidneys

Cognitive Impairment

Cognitive impairment, which may occur in 8 out of 10 patients, is the most frequent neurologic damage in SLE.11, 12

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Eye disease

Ophthalmic issues may occur in patients with SLE, with 20% of patients experiencing eye disease.20

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Bone Health

Sometimes organ damage can go unnoticed. For example, osteonecrosis, which may occur in 5% to 12% of patients, may be asymptomatic in patients with SLE.13,14

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Cardiovascular Health

Patients with SLE are at 2 to 10 times increased risk of CHD and 6 to 8 times increased risk of stroke.15,16

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Skin Manifestations

For the majority of patients, physical manifestations are common. For example, 8 in 10 patients experience skin-related symptoms.19

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Kidney Disease

In patients with SLE, renal damage is one of the most important predictors of mortality, with 6 out of 10 patients developing nephritis within 10 years of diagnosis.17,18

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Prevention of flares (especially severe flares) is a realistic target in SLE and should be a therapeutic goal.21

DID YOU KNOW?

The cost per patient* for a severe flare is approximately $12,000.22

*

Patients with SLE were extracted from a large Medicaid database 2002-2009, n = 14,777 with 14,262 matched non-SLE patients.

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.

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What Next?

Diagnosing patients can be challenging. Learn more about the intricacies and subtleties of diagnosing SLE.

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References:
1. 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. 2. Wallace DJ, Hahn B, eds. Dubois' Lupus Erythematosus. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. 3. Bernatsky S, Boivin JF, Joseph L, et al. Mortality in systemic lupus erythematosus. Arthritis Rheum. 2006;54(8):2550-2557. http://dx.doi.org/10.1002/art.21955. Accessed February 14, 2017. 4. 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. 5. Nossent J, Kiss E, Rozman B, et al. Disease activity and damage accrual during the early disease course in a multinational inception cohort of patients with systemic lupus erythematosus. Lupus. 2010;19:949-56. http://dx.doi.org/10.1177/0961203310366572. Accessed February 14, 2017. 6. Kakati S, Teronpi R, Barman B. Frequency, pattern and determinants of flare in systemic lupus erythematosus: A study from North East India. The Egyptian Rheumatologist. 2015;37:S55–S59. http://dx.doi.org/10.1016/j.ejr.2015.08.002. Accessed February 14, 2017. 7. Steiman AJ, et al. [abstract]. Frequency and characteristics of prolonged remission in systemic lupus erythematosus. Arthritis Rheum. 2011;63(Suppl 10):1388. http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=781&id=96128. Accessed February 14, 2017. 8. Thamer M, Herman MA, Zhang Y, et al. Prednisone, lupus activity, and permanent organ damage. J Rheumatol. 2009;36:560-64. http://dx.doi.org/10.3899/jrheum.080828. Accessed February 14, 2017. 9. Gladman DD, Urowitz MB, Rahman P, et al. Accrual of organ damage over time in patients with systemic lupus erythematosus. J Rheumatol. 2003;30:1955-59. http://www.jrheum.org/content/30/9/1955.abstract. Accessed February 14, 2017. 10. 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):491-8. http://dx.doi.org/10.1093/rheumatology/ker368. Accessed February 14, 2017. 11. 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. 12. 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. 13. Houssiau FA, N'Zeusseu Toukap A, et al. Magnetic resonance imaging detected avascular osteonecrosis in systemic lupus erythematosus: lack of correlation with antiphospholipid antibodies. Br J Rheumatol. 1998;37(4):448-53. http://dx.doi.org/10.1093/rheumatology/37.4.448. Accessed February 14, 2017. 14. 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%20chapter20_mod%2017.pdf. 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. 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):408-15. http://aje.oxfordjournals.org/content/145/5/408.long. Accessed February 14, 2017. 17. Danila MI, Pons-Estel GJ, Zhang J, et al. Renal damage is the most important predictor of mortality within the damage index: data from LUMINA LXIV, a multiethnic US cohort. Rheumatology (Oxford). 2009;48(5):542-5. http://dx.doi.org/10.1093/rheumatology/kep012. 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. 2012;64(6):797-808. http://dx.doi.org/10.1002/acr.21664. Accessed February 14, 2017. 19. 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. 20. 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. 21. van Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis. [published online ahead of print April 16, 2014]. 22. Kan HJ, Song X, Johnson BH, et al. Healthcare utilization and costs of systemic lupus erythematosus in Medicaid. Biomed Res Int. 2013;2013:80839. http://dx.doi.org/10.1155/2013/808391. Accessed February 14, 2017.