Long-Term Outcome in Systemic Lupus Erythematosus; Knowledge from Population-Based Cohorts

Area of Science:

• Rheumatology
• Epidemiology
• Public Health

Background:

• Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with significant health implications.
• Understanding the true burden of SLE requires accurate data on patient outcomes.
• Key outcomes of concern include mortality, end-stage renal disease (ESRD), and cancer incidence.

Purpose of the Study:

• To systematically review and synthesize findings from population-based studies on mortality, ESRD, and cancer in SLE patients.
• To identify gaps in the existing literature regarding SLE outcomes.

Main Methods:

• A systematic literature search was conducted in MEDLINE and Embase.
• Studies included were population-based and required verified SLE diagnoses.
• The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Main Results:

• Forty studies were included, focusing on mortality (27), ESRD (11), and cancer (3).
• The standardized mortality ratio in SLE cohorts ranged from 1.9 to 4.6.
• Cardiovascular disease was the leading cause of death in studies with over 15 years of follow-up.
• SLE progressed to ESRD in 5-11% of patients.
• No population-based inception cohorts showed increased cancer incidence.

Conclusions:

• There is a critical need for more population-based studies on SLE outcomes.
• Future research should prioritize inception studies with control groups and extended follow-up (over 15 years).
• Further investigation is required to fully elucidate cancer risks in SLE.