Global trends, potential mechanisms and early detection of organ damage in SLE
Anselm Mak1, David A Isenberg, Chak-Sing Lau
1Division of Rheumatology, Department of Medicine, University Medicine Cluster, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228. mdcam@nus.edu.sg
Insights
Systemic lupus erythematosus (SLE) patients are living longer, but chronic organ damage, especially cardiovascular, neuropsychiatric, and renal, limits survival. Early detection and treatment of this damage are crucial for improving longevity in SLE patients.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Increasing longevity in Systemic Lupus Erythematosus (SLE) patients has shifted focus to chronic organ damage.
- Cardiovascular, neuropsychiatric, and renal damage are significant contributors to morbidity and mortality in SLE.
- Current strategies focus on acute injury, necessitating a parallel approach for managing chronic damage.
Purpose of the Study:
- To review the global patterns and trends of organ damage in SLE.
- To explore potential serological and genetic mechanisms underlying SLE-related organ damage.
- To discuss advancements in early detection tools for SLE organ damage.
Main Methods:
- Meta-analysis of over 70 observational studies.
- Worldwide lupus center observations.
- Review of current research on diagnostic tools and risk models.
Main Results:
- Organ damage, particularly cardiovascular, has increased over the past four decades.
- Neuropsychiatric and renal damage remain key factors limiting survival in SLE.
- Early diagnosis and immunosuppression are vital for acute injury, but chronic damage management is key for long-term survival.
Conclusions:
- Managing chronic organ damage is essential for improving survival in SLE patients.
- Early detection and timely treatment of organ damage, alongside meticulous monitoring, are critical.
- Advances in imaging, biomarkers, and risk models offer promise for early detection of SLE-related organ damage.
Abstract:
Increased longevity of patients with systemic lupus erythematosus (SLE) leads to chronic organ damage accrual, which reduces the possibility of further survival improvement in patients with the disease. Observations from lupus centres worldwide revealed that the prevalence of damage occurring in the cardiovascular system in patients with SLE has increased over the past four decades. The results of a meta-analysis involving over 70 observational studies demonstrated that lupus-related organ damage involving the neuropsychiatric and renal systems also remains a major factor that limits survival improvement in patients with this disease. While efforts to halt acute lupus-related injury are continuing, through early diagnosis and effective use of immunosuppressive agents, a concomitant strategy to improve survival of patients with SLE would be early detection and timely treatment of lupus-related organ damage with meticulous monitoring. This Review discusses the pattern and trend of organ damage in patients with SLE worldwide, the potential serological and genetic mechanisms of organ damage, and the advances in research on potential tools for early detection of lupus-related organ damage, such as functional brain imaging techniques, measurement of endothelial function, identification of biomarkers from body fluids, and development of risk calculation models.
