Lupus Raises Mortality by 67%; Young Adults at Highest Risk

Janis C. Kelly

February 02, 2016

Mortality was 67% higher for patients with systemic lupus erythematosus (SLE) than for adults without SLE, although circulatory system disease and malignancies were the most common causes of death for both groups, according to an analysis of lupus mortality in the United Kingdom between 1999 and 2012. And the mortality rate was more than three times higher for patients with SLE who were younger than 40 years than for young adults without the rheumatic disease.

Frances Rees, BMBS, MRCP, from the Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, United Kingdom, and colleagues published their analysis online January 8 in Rheumatology.

"This suggests that clinicians should be particularly vigilant for treating active disease in young adults, with an emphasis on early diagnosis and early treatment to prevent early mortality," they write.

"In all adults, the emphasis should be the ongoing need for screening and management of risk factors for CVD and malignancy, as recommended in international guidelines."

The retrospective cohort study compared mortality rates among 2740 patients with lupus with those of age-, sex-, and practice-matched control participants, using the UK Clinical Practice Research Datalink. Each new case of SLE occurring between 1999 and 2012 was matched to four control participants, and outcomes were compared using mortality rate ratios.

The researchers identified 2740 incident SLE cases, 227 of whom died, for a mortality rate of 15.84/1000 person-years. Among the 10,922 matched controls there were 553 deaths, for a mortality rate of 9.51/1000 person-years (95% confidence interval, 8.75 - 10.34). The mortality rate ratio was 1.67 (95% CI, 1.43 - 1.94) for cases vs controls.

The analysis also showed that males with SLE were about twice as likely to die at any given time as females with SLE. Males with SLE were also 80% more likely to die at any given time than males without SLE, and females with SLE were about 64% more likely to die at any given time than females without SLE.

The relative risk for death was highest at younger ages for patients with SLE but nearly the same by age 80 years, as age-specific mortality increased over time for both groups.

Circulatory system disease was the most common cause of death for SLE cases and the second most common for controls. Malignancy was the most common cause of death for controls and the second most common for patients with SLE. Musculoskeletal system and connective tissue diseases were the third most common cause of death in patients with SLE.

The authors suggest that improvements in treatment for SLE appear to have reduced mortality related to connective tissue disease and musculoskeletal disorders, but that patients with lupus are still dying of other causes at higher rates and younger ages than similar patients without lupus. They emphasize the need for more efforts to reduce mortality among young people with SLE.

The study was supported by Lupus UK. Coauthor Michael Doherty, MD, is on ad hoc advisory boards on osteoarthritis and gout for AstraZeneca, Nordic Biosciences, and Novartis and has received funding from AstraZeneca for a Sons of Gout research project. The other authors have disclosed no relevant financial relationships.

Rheumatology. Published online January 8, 2016. Abstract

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