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Cited by 1,377Systemic Lupus Erythematosus ResearchSystemic Sclerosis and Related DiseasesVasculitis and related conditions

Morbidity and Mortality in Systemic Lupus Erythematosus During a 10-Year Period: A Comparison of Early and Late Manifestations in a Cohort of 1,000 Patients

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Cervera, Ricard, Khamashta, Munther A., Font, Josep, Sebastiani, Gian Domenico, Gil, Antonio, Lavilla, Paz, Mejía, Juan Carlos, Aydintug, A. Olcay +12 more·2003·Medicine
DOI 10.1097/01.md.0000091181.93122.55
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Abstract

In the present study, we assessed the frequency and characteristics of the main causes of morbidity and mortality in systemic lupus erythematosus (SLE) during a 10-year period and compared the frequency of early manifestations with those that appeared later in the evolution of the disease. In 1990, we started a multicenter study of 1,000 patients from 7 European countries. All had medical histories documented and underwent medical interview and routine general physical examination when entered in the study, and all were followed prospectively by the same physicians during the ensuing 10 years (1990-2000).A total of 481 (48.1%) patients presented 1 or more episodes of arthritis at any time during the 10 years, 311 (31.1%) patients had malar rash, 279 (27.9%) active nephropathy, 194 (19.4%) neurologic involvement, 166 (16.6%) fever, 163 (16.3%) Raynaud phenomenon, 160 (16.0%) serositis (pleuritis and/or pericarditis), 134 (13.4%) thrombocytopenia, and 92 (9.2%) thrombosis. When the prevalences of the clinical manifestations during the initial 5 years of follow-up (1990-1995) were compared with those during the ensuing 5 years (1995-2000), most manifestations were found to be more frequent during the initial 5 years. Of the 1,000 patients, 360 (36%) presented infections, 169 (16.9%) hypertension, 121 (12.1%) osteoporosis, and 81 (8.1%) cytopenia due to immunosuppressive agents. Twenty-three (2.3%) patients developed malignancies; the most frequent primary localizations were the uterus and the breast.Sixty-eight (6.8%) patients died, and the most frequent causes of death were similarly divided between active SLE (26.5%), thromboses (26.5%), and infections (25%). A survival probability of 92% at 10 years was found. A lower survival probability was detected in those patients who presented at the beginning of the study with nephropathy (88% versus 94% in patients without nephropathy, p = 0.045). When the causes of death during the initial 5 years of follow-up (1990-1995) were compared with those during the ensuing 5 years (1995-2000), active SLE and infections (28.9% each) appeared to be the most common causes during the initial 5 years, while thromboses (26.1%) became the most common cause of death during the last 5 years.In conclusion, most of the SLE inflammatory manifestations appear to be less common after a long-term evolution of the disease, probably reflecting the effect of therapy as well as the progressive remission of the disease in many patients. Meanwhile, a more prominent role of thrombotic events is becoming evident, affecting both morbidity and mortality in SLE.

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  • In a 10-year prospective study, thrombosis was the cause in 26.7% of SLE patients who died, and was always associated with the presence of aPL.

    “In a 10-year prospective study, thrombosis was found as the cause in 26.7% of SLE patients who died, and was always associated with the presence of aPL [7].”

    From Antiphospholipid patterns predict risk of thrombosis in systemic lupus erythematosus (2021) · cites this paper as [7]

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Authors
Cervera, R., Khamashta, M. A., Font, J., Sebastiani, G. D., Gil, A., Lavilla, P., Mejía, J. C., Aydintug, A. O., Chwalinska-Sadowska, H., de Ramón, E., Fernández-Nebro, A., Galeazzi, M., Valen, M., Mathieu, A., Houssiau, F., Caro, N., Alba, P., Ramos-Casals, M., Ingelmo, M., & Hughes, G. R. V.
Affiliations
St Thomas' Hospital (GB)
ORCID
Venue
Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-09
Volume
82
Issue
5
Pages
299-308
ISSN
0025-7974 (ISSN-L)
DOI
10.1097/01.md.0000091181.93122.55
OpenAlex
W2107871522
Cited by
1,377
References
36
Citations by year
2026: 25 · 2025: 62 · 2024: 65 · 2023: 57 · 2022: 61 · 2021: 80 · 2020: 72 · 2019: 69 · 2018: 70 · 2017: 77 · 2016: 76 · 2015: 84 · 2014: 71 · 2013: 79 · 2012: 88
FWCI
17.97
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • Use Siena air (University of Siena) (submittedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
Keywords
systemic lupus erythematosus, morbidity, mortality, disease manifestations, lupus nephritis, thrombosis, infection, mortality risk factors, cancer, arthritis, malar rash, serositis, Raynaud's phenomenon, neurological involvement, hypertension, osteoporosis, multicenter cohort
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Child, Europe, Female, Humans, Lupus Erythematosus, Systemic, Male, Predictive Value of Tests, Prospective Studies, Chi-Square Distribution, Logistic Models, Survival Analysis

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