Prognosis

Mortality

A European inception cohort of 1000 patients drawn from 7 countries reported 5-year survival of 95% and 10-year survival of 92%.[154][155]

Patients with SLE have higher rates of death from all causes, regardless of sex, ethnicity, renal disease, cardiovascular disease, or infection. However, the risk of death due to malignancy is not increased.[156] 

The most common cause of mortality is cardiovascular disease, followed closely by infection and severe disease activity.[157] There are differences in survival based on ethnicity, socioeconomic status, age, and sex. 

Early mortality is related to active disease (primarily renal and central nervous system), thrombosis, and infection. Later deaths are due to infection and premature atherosclerotic vascular disease; it is yet to be clarified whether this is iatrogenic or due to the underlying disease process.

Mucocutaneous disease

Outcome is determined by the number and severity of systemic complications; 20% of patients with chronic discoid lupus develop systemic disease, usually of the non-organ-threatening variety.

Smoking is known to exacerbate skin disease.

Musculoskeletal disease

Tenosynovitis may result in tendon ruptures or, less frequently, Jaccoud's arthritis. Correctable ulnar deviation and joint subluxations in the hands in the absence of radiological damage is characteristic.

Serositis

Persistent exudative pleural and pericardial effusions can arise. Outcome is a function of the local effects of their occurrence.

Renal disease

Outcome is determined by the renal histological International Society of Nephrology/Renal Pathology Society grade and severity index as well as the extent of renal impairment. Combined treatment with corticosteroids and cyclophosphamide to induce remission and substitution with azathioprine has improved outcome, but other therapeutic strategies to minimise iatrogenic complications are being developed. Improvements in renal replacement therapy have resulted in commensurate improvements in those who progress to end-stage renal disease.

Central nervous system (CNS) disease

The presence of CNS manifestations is associated with poorer outcomes, but the site and extent of damage has to be taken into consideration.

Respiratory disease

Patients with SLE-associated pulmonary hypertension have poor long-term survival. Early diagnosis and management are recommended for better outcomes.[158]

Cardiovascular disease

Causes of cardiovascular events in SLE are multifactorial, including both traditional and disease-specific risk factors (presence of auto-antibodies and neurological disorders).[159]

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