Systemic Lupus Erythematosus, An Issue of Rheumatic Disease Clinics , livre ebook

Rheumatic Disease Clinics of NA , Vol. 36, No. 1, February 2010
ISSN: 0889-857X
doi: 10.1016/S0889-857X(10)00006-2

Contributors
Rheumatic Disease Clinics of NA
Systemic Lupus Erythematosus
Ellen M. Ginzler
Division of Rheumatology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
ISSN  0889-857X
Volume 36 • Number 1 • February 2010

Contents
Cover
Contributors
Forthcoming Issues
Preface
Changing Worldwide Epidemiology of Systemic Lupus Erythematosus
Health-Related Quality of Life and Employment Among Persons with Systemic Lupus Erythematosus
Cutaneous Lupus and the Cutaneous Lupus Erythematosus Disease Area and Severity Index Instrument
Pediatric Lupus—Are There Differences in Presentation, Genetics, Response to Therapy, and Damage Accrual Compared with Adult Lupus?
The Metabolic Syndrome in Systemic Lupus Erythematosus
Gonadal Failure with Cyclophosphamide Therapy for Lupus Nephritis: Advances in Fertility Preservation
B-cell Biology and Related Therapies in Systemic Lupus Erythematosus
Biomarkers in Lupus Nephritis
Endothelial Function and its Implications for Cardiovascular and Renal Disease in Systemic Lupus Erythematosus
Cell-Bound Complement Biomarkers for Systemic Lupus Erythematosus: From Benchtop to Bedside
Interferon-alpha: A Therapeutic Target in Systemic Lupus Erythematosus
Glutamate Receptor Biology and its Clinical Significance in Neuropsychiatric Systemic Lupus Erythematosus
Index
Rheumatic Disease Clinics of NA , Vol. 36, No. 1, February 2010
ISSN: 0889-857X
doi: 10.1016/S0889-857X(10)00008-6

Forthcoming Issues
Rheumatic Disease Clinics of NA , Vol. 36, No. 1, February 2010
ISSN: 0889-857X
doi: 10.1016/j.rdc.2009.12.013

Preface

Ellen M. Ginzler, MD, MPH
Division of Rheumatology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
E-mail address: ellen.ginzler@downstate.edu


Ellen M. Ginzler, MD, MPH Guest Editor
During the past 5 years since the last issue of Rheumatic Disease Clinics of North America was devoted to systemic lupus erythematosus (SLE), new paradigms for treatment have emerged, and advances in immunologic mechanisms and pathophysiology of clinical manifestations have provided a framework for further developments in care and response to therapy. The following 12 articles are directed toward improving the understanding of cutting-edge improvements in lupus biology and providing suggestions for new regimens designed to increase efficacy and minimize adverse events.
Vasudevan and Krishnamurthy discuss the changing worldwide epidemiology and outcomes of SLE, correlating them with a unique association with the human development index and standards of living in various regions of the world. Yazdany and Yelin continue a discussion of health-related quality of life and employment among lupus patients. Articles covering specific features of SLE and their relationship to therapy include those by Klein, Morganroth, and Werth regarding cutaneous manifestations and the newly validated CLASI instrument; differences between pediatric and adult lupus by Mina and Brunner; and the metabolic syndrome in SLE by Parker and Bruce. Recommendations for gonadal protection in association with immunosuppressive therapy are made by Mersereau and Dooley, whereas Ahmed and Anolik discuss investigational therapies for lupus as they relate to B-cell biology. Detection of flares of lupus nephritis and response to therapy should be aided by Manoharan and Madaio’s discussion of biomarkers, leading to the article by Clancy and Ginzler regarding endothelial function and its implications for cardiovascular and renal disease in SLE. Finally, three articles review exciting discoveries in the immunology of lupus: cell-bound complement biomarkers by Liu and coworkers; Crow’s interferon-α as a therapeutic target; and the significance of glutamate receptor biology in neuropsychiatric biology by Aranow, Diamond, and Mackay.
Rheumatic Disease Clinics of NA , Vol. 36, No. 1, February 2010
ISSN: 0889-857X
doi: 10.1016/j.rdc.2009.12.005

Changing Worldwide Epidemiology of Systemic Lupus Erythematosus

Archana Vasudevan, MD * , Aneesa Niravel Krishnamurthy, DO ,
Division of Rheumatology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 42, Brooklyn, NY 11203, USA
* Corresponding author.
E-mail address: archanarvas@gmail.com

Abstract
Developed countries have better systemic lupus erythematosus survival rates than developing countries, or countries with lower economic performance. This is in part because of a higher human development index, defined by standard of living (a marker for gross domestic product), literacy rates, and life expectancy, with contribution from ethnic variations within individual countries, and unique environmental factors.

Keywords
• Systemic lupus erythematosus • Human development index • Gross domestic product • Ethnicity • Sociodemographics • Epidemiology
Systemic lupus erythematosus (SLE) has been reported from most countries around the world. Epidemiologic studies have detailed worldwide SLE incidence and prevalence, along with the effects of gender, race, and age on presentation and mortality. 1, 2 It is known that developed countries, which have a high gross domestic product (GDP), have significantly better survival rates than developing countries, defined as those having lower economic performances. 3 However, this does not explain differences in SLE outcomes among countries of varying GDPs, which are in part due to factors such as access to health care, physician availability, educational level, and treatment compliance. The human development index (HDI) provides a more three-dimensional view of life, by addressing the previously mentioned factors. The HDI accounts not just for standard of living (an indirect marker of GDP), but also literacy rates (a measure of educational levels), and life expectancy (an index of a population’s quality of health and access to health care). 4
There is no clear definition of a developed country. For the sake of this article, however, the authors include Western Europe, the United States of America, Canada, Japan, South Korea, Singapore, Kuwait, and the United Arab Emirates, all of which share a universally high GDP and very high HDI. 3
Within the developing countries, China, India, South Africa, Brazil, Mexico, and a few Southeast Asian countries are separately categorized as newly industrialized countries, as they have outpaced their counterparts in the developing world in terms of economic growth and social development. The newly industrialized countries have medium- to high-level HDIs, with rapidly growing GDPs. 5 Finally, excluding South Africa and Tunisia, many of the countries of sub-Saharan Africa have among the lowest GDPs and HDIs in the world, and are thus considered least developed among the developing countries. 6
Outcomes in SLE survival depend on a complex interplay of many factors. In this article, the authors have categorized countries by HDI and GDP, to correlate the effects of both social and economic prosperity with SLE outcomes.

SLE in the developed world

Western Europe
Since the 1990s, several lupus registries have been established, most in the developed world. Within the German Collaborative Arthritis Database, 5% of the patients have SLE. 7 Five-year SLE survival rates from Germany are reported as high as 96.6%, with a 10-year survival rate between 83% and 90%. 8 In a small cohort of lupus nephritis patients in Germany, those diagnosed in the 1990s, compared with patients diagnosed in the 1980s, had significantly lower proteinuria, lower rates of renal failure, and less chronicity on kidney biopsy histopathology, due to earlier diagnosis and treatment. 9 In 1999 Camilleri reported his experience with 62 SLE patients from Malta, the country with the lowest GDP of the high HDI European countries ( Table 1 ). The duration of follow-up, however, was not reported, and about 10% of the patients died. 10 In a pan-European cohort of 187 SLE patients with disease duration of greater than 10 years, renal and central nervous system (CNS) involvement increased to 47% and 65%, respectively, while cutaneous, musculoskeletal, and hematologic manifestation rates remained stable. 43, 44

Table 1 Comparison of GDP per capita, HDI and the 5-year SLE survival by country


The EuroLupus project consisting of 1000 patients from Western and European countries is perhaps the best-known European lupus registry. Within this cohort, active lupus nephritis was seen in 27.9% of patients. The 10-year survival rate was 92%, with deaths caused by active SLE in 26.5% of patients, infections in 25%, and thromboses (cerebral, coronary, and pulmonary) in 26.5%. 18 The cause of death in SLE patients is increasingly attributed to cardiovascular events rather than active disease, probably due to increased survival. 8

Japan
Japan’s national SLE registry of over 50,000 patients has survival rates mirroring that of other developed countries. SLE survival in Japan has improved from 72% in the 1950s and 1960s to 94% by the 1980s. Also noted was the decrease in death from active SLE over time, while deaths caused by fatal infections and pulmonary hypertension (PAH) increased. 45

South Korea
As seen in German studies, even though the 5-year survival rates were at 93%, the overall SMR (standardized mortality ratio) was 3.02. The most common causes of death were