Systemic lupus erythematosus: epidemiology, outcomes and burden

S. Moiseev, P. Novikov, N. Bulanov
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引用次数: 1

Abstract

The estimates of incidence and prevalence of systemic lupus erythematosus (SLE) in Europe are 1.5-4.9 per 100 000 persons-years and 30-70 per 100 000 people, respectively. Over the last 50 years, survival in SLE patients has improved significantly. Moreover, immunosuppressive treatment resulted in a decreased risk of death from active disease, whereas infections and cardiovascular disease have become the main causes of death in SLE populations. Almost 70% of SLE patients have recurrent course of disease, although long-term remissions or persistent disease activity also occur in a proportion of patients. Annually, every third SLE patient develops moderately severe or severe flares. Recurrent flares, complications of immunosuppressive treatment and comorbidity are associated with accrual of organ damage that increases the risk of death. SLE patients have impaired health-related quality of life correlating with both disease activity and organ damage. Being on remission of SLE or on low disease activity is associated with better outcomes, including lower mortality and risk of damage or flares, improved quality of life, lower hospitalisation rates and costs. Glucocorticoids remain the mainstay of SLE treatment, although their use should be limited, e.g. by proper administration of immunosuppressive or antiinflammatory agents that have steroid-sparing activity. Treatment and prevention of infections and cardiovascular outcomes are also essential for further improvement of survival of SLE patients.
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系统性红斑狼疮:流行病学、结局和负担
据估计,欧洲系统性红斑狼疮(SLE)的发病率和患病率分别为每10万人年1.5-4.9例和每10万人年30-70例。在过去的50年里,SLE患者的生存率显著提高。此外,免疫抑制治疗导致活动性疾病死亡风险降低,而感染和心血管疾病已成为SLE人群死亡的主要原因。几乎70%的SLE患者有复发病程,尽管也有一部分患者出现长期缓解或持续的疾病活动。每年,每三名SLE患者中就有一名出现中度或重度的耀斑。复发性发作、免疫抑制治疗的并发症和合并症与器官损伤的累积相关,从而增加死亡风险。SLE患者的健康相关生活质量受损与疾病活动性和器官损伤相关。SLE缓解或疾病活动度低与较好的预后相关,包括较低的死亡率和损害或发作风险、改善的生活质量、较低的住院率和费用。糖皮质激素仍然是SLE治疗的主要药物,但应限制其使用,例如适当使用具有类固醇活性的免疫抑制剂或抗炎药。治疗和预防感染和心血管预后对进一步改善SLE患者的生存也至关重要。
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