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The global impact of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an inflammatory illness characterized by protean clinical features, a predilection for afflicting young females, and an unpredictable course. Manifestations range from fatigue and arthritis to life threatening carditis, cerebritis, and nephritis. Although the etiology of this disease remains elusive, its hallmark is aberrant auto-antibody production. These antibodies are either directly toxic to tissues, or form immune complexes that induce inflammation when deposited in capillary beds.1 Due to therapeutic advances over the last 50 years, the 5-year survival rate has increased from less than 50% to over 90%;2 this statistic, however, is misleading, as the long-term survival rate (68%) continues to be poor.2 The causes of mortality suffered within the first 5 years of developing SLE are often related to the disease itself (26%), or to infection (37%), in contrast to late mortality, where infection (30%) and vascular disease (30%) are major causes of death.2 The improved 5-year survival rate of SLE patients has necessitated taking a more comprehensive view of lupus patients in order to evaluate the spectrum of disease over time. Although lupus patients survive longer, they are vulnerable to cardiac disease. Women with SLE aged 35–44 years were found to have a rate of myocardial infarction 52 times that of women of the same age range without SLE.3 Protracted courses of glucocorticoids, along with the more traditional risk factors of obesity, hypercholesterolemia, hypertension, renal disease, and a sedentary lifestyle, all contribute to this excess cardiovascular disease. Factors specific to SLE, such as the presence of antiphospholipid antibodies, may contribute to increased cardiovascular morbidity. The onset of cardiac disease in lupus patients occurs 10–20 years earlier than in the general population, potentially incapacitating men and women in the prime of their lives. Although renal disease is no longer a major cause of mortality,2 significant morbidity persists. Roughly half of all patients diagnosed with SLE developing renal disease at some