Prevalence and incidence of systemic lupus erythematosus in the adult population of Estonia

Epidemiology of SLE in Italy: an observational study using a primary care database

OBJECTIVES

To estimate the incidence and prevalence of SLE in Italy, and to describe the demographic and clinical characteristics of patients with newly diagnosed SLE.

METHODS

A retrospective cohort study was conducted using The Health Improvement Network general practice database in Italy, encompassing data from 634 753 people. SLE cases were identified over the period 2017-2022, employing three alternative definitions to provide a more detailed understanding of SLE characteristics. Incidence rates were expressed as cases per 100 000 person-years and prevalence as cases per 100 000 people. Demographic and clinical characteristics of incident SLE cases were also studied.

RESULTS

From 2017 to 2022, a total of 191 incident and 1385 prevalent cases were identified under our first definition. In 2022, the incidence rate was 6.51 cases (95% CI 6.29 to 6.74) per 100 000 person-years, and the prevalence 60.57 (95% CI 59.89 to 61.25) per 100 000 people, being the prevalence five times higher in women compared with men. Both estimates have trended upwards since 2017. A geographical variation across the country was also seen. The demographic and clinical characteristics of incident SLE cases were described, while the potential associations of SLE incidence with some pre-existing conditions were observed, such as chronic kidney disease, chronic hepatic disease, rheumatoid arthritis and Sjogren's syndrome.

CONCLUSIONS

The results of this nationwide study, the first conducted in Italy, showed that the incidence of SLE has increased in Italy in recent years. Age, sex, and area of residence strongly correlate with the epidemiology of this condition.

Epidemiology of Sjögren's: A Systematic Literature Review

INTRODUCTION

Primary Sjögren's is a multi-system autoimmune disease affecting patients' physical, mental, and emotional wellbeing. The epidemiology of Sjögren's is not well understood, and up-to-date epidemiological evidence is needed to improve knowledge and awareness of Sjögren's among patients and healthcare professionals, and to ascertain the global burden of disease. The objective of this research was to conduct a de novo systematic literature review (SLR) to identify and synthesise evidence on global epidemiology of primary Sjögren's.

METHODS

This SLR was conducted in May 2021 by searching MEDLINE and Embase databases, relevant conference proceedings, websites of registries, and health technology assessment agencies and databases. Publications were systematically screened for English language articles reporting on the incidence, prevalence, age at symptom onset, and age at diagnosis for people with primary Sjögren's.

RESULTS

Of 3510 records identified, 68 publications were included, representing 62 unique studies. Studies reported on age at symptom onset (16/62; 25.8%) and age at diagnosis (43/62; 69.4%) more frequently than incidence (7/62; 11.3%) and prevalence (9/62; 14.5%). Primary Sjögren's was found to have the highest incidence and prevalence in females and in older age groups (incidence: ≥65 years; prevalence: ≥75 years). Average age at onset and diagnosis of primary Sjögren's ranged between 34-57 years and 40-67 years, respectively.

CONCLUSIONS

This SLR identified a paucity of incidence and prevalence data for primary Sjögren's, highlighting a need for further epidemiological studies. The global Sjögren's community must work together to follow the defined classification criteria of primary Sjögren's and reporting guidelines for incidence and prevalence data to allow for meaningful epidemiological comparisons across studies, settings, and countries.

Systemic lupus erythematosus incidence and prevalence in a large population-based study in northeastern Italy

OBJECTIVES

We aimed at estimating the incidence and prevalence of SLE in northeastern Italy over the period 2012-20.

METHODS

A retrospective population-based study was conducted in Veneto Region (4.9 million people) using the population registry, an administrative health database where all residents are recorded. Between 2012 and 2020, SLE prevalence was defined by a healthcare co-payment exemption for SLE (national registry code 028) or any hospital diagnosis of SLE (International Classification of Disease , Ninth Revision, Clinical Modification 710.0), whichever came first. Incident SLE was defined from 2013 to 2020 to exclude prevalent cases. Standardized incidence and prevalence rates were reported by age and sex.

RESULTS

During the study period, we identified 4283 SLE patients (85% female), with 1092 incident cases. Across the study period, SLE standardized point prevalence increased from 63.5 (95% CI 61.2, 65.8) to 70.6 (95% CI 68.3, 73.0) per 100 000 residents, corresponding to an annual increment of 1.14% (P < 0.0001). The highest prevalence was observed in females aged 60-69 years. SLE incidence corresponded to 2.8 per 100 000 person-years (95% CI 2.6, 2.9), with an annual decline of 7.3% (P < 0.0001). Incidence was 5-fold higher in females (female-to-male incidence rate ratio: 5.00, 95% CI 4.25, 5.87; P < 0.0001), with a peak among women aged 30-39 years. At diagnosis, women were significantly younger (45 years, IQR 33-58) than men (52 years, IQR 38-64).

CONCLUSIONS

Over the last decade, SLE prevalence has increased, while incidence has stably declined. In view of the introduction of new high-cost drugs, a clear definition of the epidemiology of SLE is crucial for all healthcare stakeholders.

Comparison of the sensitivity of the EULAR / ACR 2019 and SLICC 2012 classification criteria in a Colombian population with systemic lupus erythematosus

BACKGROUND

/Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a wide range of clinical manifestations. The latest classification criteria, EULAR/ACR 2019, have not been validated in a Latin American population of Amerindian ancestry. The objective of this study is to compare the sensitivity of the EULAR/ACR 2019 and SLICC 2012 classification criteria in a group of SLE patients with the above ancestry.

METHODS

A cross-sectional study was done. Data were obtained from the review of medical records of patients who met the inclusion criteria. The overall sensitivity of the criteria was calculated and compared to each other using the McNemar test.

RESULTS

146 medical records of patients from two referral centers were included. There were no differences in the sensitivity of the EULAR/ACR and SLICC 2012 criteria (84.9% versus 85.6% p = 0.79) nor were differences found when the groups based on disease duration were compared: less than 5 years (91.0% versus 92.5% p = 0.70), between 5 and 10 years (82.8% versus 82.8% p = 1), and 10 years or more (76.7% versus 76.7% p = 1). However, SLICC 2012 criteria was found to better classify patients with a less than 5-year disease duration compared to those with 10-year duration or more (92.5% versus 76.4% p = 0.024).

CONCLUSIONS

There are no statistically significant differences between the EULAR/ACR and SLICC 2012 criteria in the population studied. Nor were differences found when evaluating them by age at diagnosis and duration of the disease except when the group with less than 5 years of duration was compared to those with 10 years or more using the SLICC 2012 criteria.

Global epidemiology of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease with protean manifestations that predominantly affects young women. Certain ethnic groups are more vulnerable than others to developing SLE and experience increased morbidity and mortality. Reports of the global incidence and prevalence of SLE vary widely, owing to inherent variation in population demographics, environmental exposures and socioeconomic factors. Differences in study design and case definitions also contribute to inconsistent reporting. Very little is known about the incidence of SLE in Africa and Australasia. Identifying and remediating such gaps in epidemiology is critical to understanding the global burden of SLE and improving patient outcomes. Mortality from SLE is still two to three times higher than that of the general population. Internationally, the frequent causes of death for patients with SLE include infection and cardiovascular disease. Even without new therapies, mortality can potentially be mitigated with enhanced quality of care. This Review focuses primarily on the past 5 years of global epidemiological studies and discusses the regional incidence and prevalence of SLE and top causes of mortality.

Fatty acid binding protein 4 (FABP4) and metabolic-related parameters in systemic lupus erythematosus active and non-active episode

OBJECTIVE

To assess serum FABP4 and other metabolic-related parameters in Systemic Lupus Erythematosus (SLE) active and non-active episode.

METHODS

Fifty-four SLE patients in Hasan Sadikin General Hospital, Bandung, Indonesia in 2018-2019 were recruited and serum samples were collected in their active and non-active episode status. Serum was analyzed for FABP4, leptin, glucose, and triglycerides. The clinical characteristics were analyzed from medical records. Disease activity was assessed with the SLEDAI-2K (≥4 defined as an active; <4 as non-active episode).

RESULTS

Significantly correlation of Systolic Blood Pressure (SBP) (p = 0.001, r = 0.59) and C3 (p = 0.04, r = 0.47) between active and non-active episode. In non-active episode, there was significant correlation of FABP4 with Diastolic Blood Pressure (DBP) (p = 0.04, r = 0.26) and blood glucose (p = 0.01, r = -0.39). In active episode, there was significant correlation FABP4 with SBP (p = 0.04, r = -0.28) and triglyceride (p = 0.002, r = 0.55).

CONCLUSION

FABP4 correlates with high DBP in the non-active and high triglyceride serum in the active episode.

Administrative database as a source for assessment of systemic lupus erythematosus prevalence: Estonian experience

Background

Administrative database research is widely applied in the field of epidemiology. However, the results of the studies depend on the type of database used and the algorithms applied for case ascertainment. The optimal methodology for identifying patients with rheumatic diseases from administrative databases is yet not known. Our aim was to describe an administrative database as a source for estimation of epidemiological characteristics on an example of systemic lupus erythematosus (SLE, ICD-10 code M32) prevalence assessment in the database of the Estonian Health Insurance Fund (EHIF).

Methods

Code M32 billing episodes were extracted from the EHIF database 2006–2010. For all cases where M32 was assigned by a rheumatologist less than four times during the study period, diagnosis verification process using health care providers’ (HCP) databases was applied. For M32 cases assigned by a rheumatologist four times or more, diagnoses were verified for a randomly selected sample.

Results

From 677 persons with code M32 assigned in EHIF database, 404 were demonstrated having “true SLE”. The code M32 positive predictive value (PPV) for the whole EHIF database was 60%; PPV varies remarkably by specialty of a physician and repetition of the code assignment. The false positive M32 codes were predominantly initial diagnoses which were not confirmed afterwards; in many cases, a rheumatic condition other than SLE was later diagnosed.

Conclusions

False positive codes due to tentative diagnoses may be characteristic for conditions with a complicated diagnosis process like SLE and need to be taken into account when performing administrative database research.

Lupus: the new epidemic

Is systemic lupus erythematosus (SLE) is occurring more frequently now than in decades past? Despite improvements in the identification of patients with SLE, the development of new classification criteria, and the recognition of several biomarkers used alone or in combination, the diagnosis of SLE is still a challenge for clinicians, in particular early in the course of the disease, which makes the recognition of secular trends difficult to ascertain. Lacking a uniform definition of preclinical lupus or incomplete lupus, it is difficult to predict accurately which patients would go on to develop SLE. We will briefly review the classification criteria, early or preclinical SLE, the epidemiology of SLE, antinuclear antibodies-negative SLE, and biomarkers of the disease.

Epidemiology of systemic lupus erythematosus: an update

PURPOSE OF REVIEW

Systemic lupus erythematosus (SLE) is the prototypical systemic autoimmune disease with a significant disease burden across the world among different ethnic, racial, and age groups. The pathophysiological understanding of SLE is constantly evolving and with it, the need for a better definition of the disease itself, for understanding the risk among the different affected populations, and for identifying the factors responsible for the damage accrual through the years.

RECENT FINDINGS

More accurate estimates of incidence and prevalence of SLE among different ethnicities and minority groups not only in the USA, but also in Europe, Middle East, and Asia have provided new insights into the disease burden around the world. Despite advances in treatment, mortality among SLE patients remains high with significant ethnic and geographic variations.

SUMMARY

Sex, race, and ethnicity significantly affect SLE incidence, prevalence, and mortality.

Epidemiology of systemic lupus erythematosus

INTRODUCTION

Systemic lupus erythematosus (SLE) is a disease distributed worldwide, which occurs in both genders, and across racial/ethnic and age groups; however, higher rates are observed in adults, in women and in non-Caucasians. Genetic, environmental, sociodemographic and methodological issues are responsible not only for these differences but for the variable course and outcome of the disease. Non-Caucasians have a more severe disease with a higher risk for early mortality and damage accrual. Males also have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood-onset is associated with a more severe disease; moreover, it is also associated with higher damage and diminished survival; finally, late-onset lupus is mild but it is associated with higher damage accrual and a diminished survival. Areas covered: In this review, we discuss the incidence and prevalence of SLE, the impact of age, gender and race/ethnicity in SLE and in the survival of those affected. Expert commentary: Age, gender and race/ethnicity impact disease expression in SLE patients; despite improvements in survival, mortality in SLE remains almost three times higher than in the general population.