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Global trends, potential mechanisms and early detection of organ damage in SLE

Nature Reviews Rheumatology volume 9, pages 301–310 (2013)Cite this article

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Abstract

Increased longevity of patients with systemic lupus erythematosus (SLE) leads to chronic organ damage accrual, which reduces the possibility of further survival improvement in patients with the disease. Observations from lupus centres worldwide revealed that the prevalence of damage occurring in the cardiovascular system in patients with SLE has increased over the past four decades. The results of a meta-analysis involving over 70 observational studies demonstrated that lupus-related organ damage involving the neuropsychiatric and renal systems also remains a major factor that limits survival improvement in patients with this disease. While efforts to halt acute lupus-related injury are continuing, through early diagnosis and effective use of immunosuppressive agents, a concomitant strategy to improve survival of patients with SLE would be early detection and timely treatment of lupus-related organ damage with meticulous monitoring. This Review discusses the pattern and trend of organ damage in patients with SLE worldwide, the potential serological and genetic mechanisms of organ damage, and the advances in research on potential tools for early detection of lupus-related organ damage, such as functional brain imaging techniques, measurement of endothelial function, identification of biomarkers from body fluids, and development of risk calculation models.

Key Points

  • Overall survival of patients with systemic lupus erythematosus (SLE) has improved substantially over the past 5 decades, but has slowed down since the 1980s, possibly owing to organ damage

  • Although the most common causes of death in patients with SLE are infection and cardiovascular disease, organ damage predicting survival mainly involves renal, cardiovascular, neuropsychiatric and respiratory systems

  • Multiple factors contributing to organ damage in SLE lead to reduction in overall and organ survival, physical function, productivity and health-related quality of life, eventually leading to psychosocial and economic burden

  • Functional MRI of the brain, endothelium-dependent flow-mediated dilatation, identification of urinary biomarkers and FRAX® assessment are potential tools to detect early neuropsychiatric, cardiovascular and renal damage, and osteoporotic fracture, respectively

  • Further evaluation, standardisation and validation of detection tools are required before they can be widely used

  • Current data suggest that a combination (panel) of biomarkers and biomarker signatures will improve accurate and powerful detection of organ involvement in SLE

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Figure 1: Possible mechanisms of chronic organ damage in SLE and the effects on outcome.

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Acknowledgements

We thank Mr Tao Ren, a PhD student at the National University of Singapore, for his editorial assistance and for providing critical comments on the draft of the manuscript.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, University Medicine Cluster, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 10, NUHS Tower Block, 119228, Singapore

    Anselm Mak

  2. Department of Medicine, Centre for Rheumatology, University College London, Room 424, The Rayne Building, 5 University Street, London, WC1E, UK

    David A. Isenberg

  3. Division of Rheumatology, University Department of Medicine, University of Hong Kong, Room 405B, 4/F Professorial Block, Queen Mary Hospital, Pok Fu Lam Road, Hong Kong

    Chak-Sing Lau

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A. Mak researched the data for the article. All authors contributed substantially to discussion of content, writing, reviewing and editing of the manuscript before submission.

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Mak, A., Isenberg, D. & Lau, CS. Global trends, potential mechanisms and early detection of organ damage in SLE. Nat Rev Rheumatol 9, 301–310 (2013). https://doi.org/10.1038/nrrheum.2012.208

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