Long-term analysis of clinical disease activity and chronic organ damage in patients with systemic lupus erythematosus

Background Systemic lupus erythematosus is a chronic inflammatory and systemic disease with multiple symptoms which is often characterized by a course of exacerbations. Over the last few decades the prognosis of SLE considerably improved with > 90% patients living more than 10 years with their disease. Aim of the study and methods The aim of this retrospective-descriptive analysis of 65 patients with the diagnosis of SLE (based on the ARA criteria) was to investigate the symptoms and the laboratory values at the time of diagnosis (TD) and over a period of 10 years (10 Y) in the outpatient university clinic of the Department of Nephrology and Rheumatology at Goettingen. In addition to symptoms and laboratory values, disease activity, exacerbations, chronic organ failure, and medical therapy were to be investigated. Results The long-term analysis revealed a decline in the prevalence of ANAs (TD: 95.6%; > 10 Y: 78.6%), ds-DNA antibodies (TD: 78.0%; >10 Y: 46.7%) and pathological levels of the complement component C3 (TD: 72.7%; > 10 Y: 42.9%) over time. The symptoms most prevalent at the time of first diagnosis such as the typical butterfly rash (TD: 50.0,%; > 10 Y: 36.8%), discoid skin lesions (TD: 38.8%; > 10 Y: 23.5%) were noted less often after a 10 year-disease course. On the contrary the frequency of arthralgias (TD: 61.2%; > 10 Y: 57.9%), myalgias (TD: 26.1%; > 10 Y: 26.3%) and fatigue (TD: 63.0%; > 10 Y: 64.7%) remained stable over time. The prevalence of arterial hypertension (TD: 17.2%; > 10 Y: 54.5%), proteinuria (TD: 33.3%; > 10 Y. 66.7%) and erythrocyturia (TD: 27.8%; > 10 Y: 44.4%) remarkably increased during the disease course. Besides renal damage, coronary artery disease (TD: 6.0%; > 10 Y: 23.0%) and neurological disease (e.g., cerebrovascular insults) (TD: 10.9%; > 10 Y: 26.3%) were noted more often after 10 years. Of patients, 56.9% developed one or several exacerbations of the disease. In all cases, clinical symptoms correlated with an increase in the level of ds-DNA-antibodies and a decrease of C3-complement component. Other medications included immunosuppressants, antihypertensive drugs and NSAIDs. High-dose steroids were preferred as the first diagnosis (TD: 44.4%; > 10 Y: 11.1 %), while low-dose steroids were more often prescribed after a 10-years diseases course (TD: 6.7%; > 10 Y: 27.8%). Conclusions There is a shift towards secondary organ damage with a decline of the inflammatory activity in patients with SLE after 10 years of disease. These consecutive diseases are due to the primary damage of SLE as well as to medical treatment (e.g., with steroids).