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Entwicklung von Mortalität und Morbidität beim systemischen Lupus erythematodes

Changes in mortality and morbidity in systemic lupus erythematosus

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Zusammenfassung

Der systemische Lupus erythematodes stellt als chronisch verlaufende Multisystemerkrankung trotz optimierter Behandlungsregimes unverändert eine klinische Herausforderung dar. Langzeituntersuchungen konnten in der Vergangenheit eine Abnahme der Mortalität belegen. Dieser Trend setzt sich auch in den letzten beiden Jahrzehnten fort. Dennoch ist die Lebenserwartung im Vergleich zur Normalbevölkerung weiterhin deutlich eingeschränkt. Neben der Krankheitsaktivität sind Infektionen und kardiovaskuläre Erkrankungen die Haupttodesursachen. Während sowohl die durch die Erkrankung selbst als auch durch Infektionen bedingten Todesfälle aber über die Jahre rückläufig sind, imponiert eine Zunahme kardiovaskulärer Erkrankungen. Ersteres kann durch die individuell angepassten Therapiekonzepte und den vorsichtigeren Einsatz von Steroiden erklärbar sein; dagegen sind die kardiovaskulären Komplikationen auf das längere Überleben der Patienten und die beschleunigte Arteriosklerose zurückzuführen. Dieser Langzeitaspekt muss bereits in frühen Phasen der Erkrankung bei der Behandlung von Aktivität und Komorbiditäten berücksichtigt werden.

Abstract

Systemic lupus erythematosus (SLE) is a chronic multisystem disease and despite the improvements in treatment, long-term care still represents a clinical challenge. Previous long-running studies have demonstrated a continuous improvement in mortality and this trend has persisted over the last two decades. However, there still remains a significantly increased mortality in comparison to the normal population. Besides deaths caused by disease activity, cardiovascular and infectious diseases also play a major role. While deaths caused by SLE activity or infections have declined over the years, there has been a notable increase in cardiovascular diseases. As the improvement of SLE activity and infections can be traced back to individually optimized treatment regimes and the more cautious use of steroids, the cardiovascular complications are due to accelerated atherosclerosis and the improved survival with ageing of the patients. This long-term aspect needs to be taken into account in the early stages of disease when treating disease activity and comorbidities.

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Literatur

  1. Abu-Shakra M, Urowitz MB, Gladman DD, Gough J (1995) Mortality studies in systemic lupus erythematosus. Results from a single center.I. Causes of death. J Rheumatol 22:1259–1264

    PubMed  CAS  Google Scholar 

  2. Alamanos Y, Voulgari PV, Papassava M et al (2003) Survival and mortality rates of systemic lupus erythematosus patients in northwest Greece. Study of a 21-year incidence cohort. Rheumatology (Oxford) 42:1122–1123

    Google Scholar 

  3. Alarcón GS, McGwin G, Bastian HM et al (2001) Systemic lupus erythematosus in three ethnic groups. VII [correction of VIII]. Predictors of early mortality in the LUMINA cohort. LUMINA Study Group. Arthritis Rheum 45:191–202

    Article  PubMed  Google Scholar 

  4. Bernatsky S, Boivin J, Joseph L et al (2006) Mortality in systemic lupus erythematosus. Arthritis Rheum 54:2550–2557

    Article  PubMed  CAS  Google Scholar 

  5. Bertsias G, Ioannidis JP, Boletis J et al (2008) EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 67:195–205

    Article  PubMed  CAS  Google Scholar 

  6. Blanco FJ, Gómez-Reino JJ, La Mata J de et al (1998) Survival analysis of 306 European Spanish patients with systemic lupus erythematosus. Lupus 7:159–163

    Article  PubMed  CAS  Google Scholar 

  7. Bongu A, Chang E, Ramsey-Goldman R (2002) Can morbidity and mortality of SLE be improved? Best Pract Res Clin Rheumatol 16:313–332

    Article  PubMed  Google Scholar 

  8. Cervera R, Khamashta MA, Font J et al (1999) Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 78:167–175

    Google Scholar 

  9. Cervera R, Khamashta MA, Font J et al (2003) 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. Medicine (Baltimore) 82:299–308

    Google Scholar 

  10. Chiu M, Austin PC, Manuel DG, Tu JV (2010) Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007. CMAJ 182:E301–310

    Article  PubMed  Google Scholar 

  11. Doria A, Iaccarino L, Ghirardello A et al (2006) Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med 119:700–706

    Article  PubMed  Google Scholar 

  12. Gladman DD, Hussain F, Ibañez D, Urowitz MB (2002) The nature and outcome of infection in systemic lupus erythematosus. Lupus 11:234–239

    Article  PubMed  CAS  Google Scholar 

  13. Goldblatt F, Chambers S, Rahman A, Isenberg DA (2009) Serious infections in British patients with systemic lupus erythematosus: hospitalisations and mortality. Lupus 18:682–689

    Article  PubMed  CAS  Google Scholar 

  14. Gordon MF, Stolley PD, Schinnar R (1981) Trends in recent systemic lupus erythematosus mortality rates. Arthritis Rheum 24:762–769

    Article  PubMed  CAS  Google Scholar 

  15. Hochberg MC (1987) Mortality from systemic lupus erythematosus in England and Wales, 1974–1983. Br J Rheumatol 26:437–441

    Article  PubMed  CAS  Google Scholar 

  16. Jacobsen S, Petersen J, Ullman S et al (1999) Mortality and causes of death of 513 Danish patients with systemic lupus erythematosus. Scand J Rheumatol 28:75–80

    Article  PubMed  CAS  Google Scholar 

  17. Kang I, Park SH (2003) Infectious complications in SLE after immunosuppressive therapies. Curr Opin Rheumatol 15:528–534

    Article  PubMed  CAS  Google Scholar 

  18. Kasitanon N, Magder LS, Petri M (2006) Predictors of survival in systemic lupus erythematosus. Medicine (Baltimore) 85:147–156

    Google Scholar 

  19. Manger K, Manger B, Repp R et al (2002) Definition of risk factors for death, end stage renal disease, and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus. Ann Rheum Dis 61:1065–1070

    Article  PubMed  CAS  Google Scholar 

  20. Manzi S, Meilahn EN, Rairie JE et al (1997) Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 145:408–415

    PubMed  CAS  Google Scholar 

  21. Mok C, Kwok C, Ho L et al (2011) Life expectancy, standardized mortality ratios and causes of death of six rheumatic diseases in Hong Kong, China. Arthritis Rheum 63(5):1182–1189

    Article  PubMed  CAS  Google Scholar 

  22. Mosca M, Tani C, Aringer M et al (2010) European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 69:1269–1274

    Article  PubMed  CAS  Google Scholar 

  23. Navarra SV, Leynes MSN (2010) Infections in systemic lupus erythematosus. Lupus 19:1419–1424

    Article  PubMed  CAS  Google Scholar 

  24. Nossent J, Cikes N, Kiss E et al (2007) Current causes of death in systemic lupus erythematosus in Europe, 2000–2004: relation to disease activity and damage accrual. Lupus 16:309–317

    Article  PubMed  CAS  Google Scholar 

  25. Petri M, Spence D, Bone LR, Hochberg MC (1992) Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: prevalence, recognition by patients, and preventive practices. Medicine (Baltimore) 71:291–302

  26. Petri M, Perez-Gutthann S, Longenecker JC, Hochberg M (1991) Morbidity of systemic lupus erythematosus: role of race and socioeconomic status. Am J Med 91:345–353

    Article  PubMed  CAS  Google Scholar 

  27. Rubin LA, Urowitz MB, Gladman DD (1985) Mortality in systemic lupus erythematosus: the bimodal pattern revisited. Q J Med 55:87–98

    PubMed  CAS  Google Scholar 

  28. Swaak AJ, Nossent JC, Smeenk RJ (1991) Prognostic factors in systemic lupus erythematosus. Rheumatol Int 11:127–132

    Article  PubMed  CAS  Google Scholar 

  29. Uramoto KM, Michet CJ, Thumboo J et al (1999) Trends in the incidence and mortality of systemic lupus erythematosus, 1950–1992. Arthritis Rheum 42:46–50

    Article  PubMed  CAS  Google Scholar 

  30. Urowitz MB, Bookman AA, Koehler BE et al (1976) The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 60:221–225

    Article  PubMed  CAS  Google Scholar 

  31. Urowitz MB, Ibañez D, Gladman DD (2007) Atherosclerotic vascular events in a single large lupus cohort: prevalence and risk factors. J Rheumatol 34:70–75

    PubMed  Google Scholar 

  32. Urowitz MB, Gladman DD, Tom BD M et al (2008) Changing patterns in mortality and disease outcomes for patients with systemic lupus erythematosus. J Rheumatol 35:2152–2158

    Article  PubMed  Google Scholar 

  33. Walsh SJ, DeChello LM (2001) Geographical variation in mortality from systemic lupus erythematosus in the United States. Lupus 10:637–646

    Article  PubMed  CAS  Google Scholar 

  34. Ward MM, Pyun E, Studenski S (1995) Long-term survival in systemic lupus erythematosus. Patient characteristics associated with poorer outcomes. Arthritis Rheum 38:274–283

    Article  PubMed  CAS  Google Scholar 

  35. Ward MM, Pyun E, Studenski S (1995) Causes of death in systemic lupus erythematosus. Long-term followup of an inception cohort. Arthritis Rheum 38:1492–1499

    Article  PubMed  CAS  Google Scholar 

  36. Ward MM, Pyun E, Studenski S (1996) Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus. Arch Intern Med 156:1337–1344

    Article  PubMed  CAS  Google Scholar 

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  1. Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    G. Chehab, R. Fischer-Betz & M. Schneider

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  1. G. Chehab
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  2. R. Fischer-Betz
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  3. M. Schneider
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Correspondence to G. Chehab.

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Chehab, G., Fischer-Betz, R. & Schneider, M. Entwicklung von Mortalität und Morbidität beim systemischen Lupus erythematodes. Z. Rheumatol. 70, 480–485 (2011). https://doi.org/10.1007/s00393-011-0758-x

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