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Systemic lupus erythematosus

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Abstract

Systemic lupus erythematosus (SLE) is one of the most diverse autoimmune diseases as it may affect any organ in the body and display a broad spectrum of clinical and immunological manifestations. Epidemiological studies have identified marked differences in the prevalence and course of SLE between genders, and across different ages, races and geographic locations. Methodological differences between studies may account for some of the disparity seen. Additionally, some insights into possible environmental risk factors for SLE have also been provided. As this condition is relatively uncommon, multifactorial, and largely influenced by genetic predisposition, it is inherently difficult to confirm or exclude infectious or environmental contributors to its etiology. Movement of people between communities and defining specific exposures can also be problematic. Despite these limitations, ongoing observation of SLE cohorts in multiple countries and settings, along with large international cooperative efforts in recent years, have helped clarify the risks of SLE in various groups and have defined marked differences in the worldwide occurrence of the disease.

Section snippets

Descriptive epidemiology

SLE is one of the most diverse auto-immune diseases as it may affect any organ in the body and display a broad spectrum of clinical and immunological manifestations. Although it has been considered a rare disease, it now appears to be relatively common in certain groups of the population. This is most likely due to the development of immunological tests that have allowed the diagnosis of many atypical or benign cases, that otherwise may not have been identified. Several descriptive

Geographical difference in occurrence or outcome

The incidence and prevalence of SLE has consistently been found to be higher in patients with African ancestry. For example, a study in Birmingham, UK, found a higher age-adjusted incidence and prevalence in Afro-Caribbean subjects than in white people [13]. Age-adjusted incidence rates were 25.8 and 4.3 per 100 000 persons per year in Afro-Caribbean subjects and white subjects, respectively, and prevalence rates were 112 and 21 per 100 000 persons. In this study, the age distribution of

What are the relevant risk factors for the occurrence of the condition?

In addition to the racial and geographic differences in the occurrence of SLE discussed above, there are a number of epidemiological factors that appear important determinants of SLE risk. However, none of the factors below is a prerequisite for developing SLE, highlighting the multifactorial nature of the condition.

What are the time trends?

The incidence of SLE is increasing [11], [14]. As discussed above, mortality in SLE is improving. The likely reasons for this include increased recognition of mild SLE, improvements in the management of renal disease, infection and malignancy and an increased awareness of steroid side effects when compared with reports from the 1960s. There are numerous methodological difficulties in identifying which of these factors have made the greatest contribution to the improvement in SLE mortality.

Difficulties in obtaining this information: what are the weaknesses of the data reported above?

There are a number of challenges in identifying true differences in the occurrence and course of SLE, rather than differences in epidemiological methods [130]. As discussed above, changes in the classification criteria for SLE in 1982 [2] and 1997[3] make it difficult to compare recent data with data from the 1970s and earlier.

Case ascertainment is also an issue in comparing studies of SLE. Differing studies have used hospital records, tertiary referral cohorts or community cohorts as the

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