Systemic Lupus Erythematosus: A Primer for Managed Care

Although systemic lupus erythematosus (SLE) is often called “lupus,” there are actually 4 different kinds of lupus, of which SLE is the most common form. In addition to SLE, there is discoid lupus erythematosus, drug-induced lupus erythematosus, and neonatal lupus. Discoid, or cutaneous, lupus is limited to the skin, where it manifests as a variety of different rashes.¹ Drug-induced lupus, which appears similar to SLE, usually dissipates within several weeks of discontinuation of the drugs that caused it.^2,3 Neonatal lupus is quite rare, and is caused by a mother’s antibodies being passed on to the fetus. SLE is usually what is referred to when the word “lupus” is used.⁴

SLE is a rare autoimmune disease. In 2008, it has been estimated that between 161,000 and 322,000 American adults had SLE.⁵ Most of these adults are women in their childbearing years. The Euro Lupus Project analyzed 1000 patients with SLE; 91% were women, and the mean age at the onset of symptoms was 29 years.⁶ The impact of SLE on pregnancies can be severe. A meta-analysis calculated that 16% of pregnancies in women with SLE resulted in spontaneous abortion and 6.1% resulted in stillbirth or neonatal death. Overall, nearly a quarter of all pregnancies were unsuccessful in women with SLE and 39% of births were premature.⁷

Please visit ajmc.com/sle for the interactive presentation on SLE.

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1. Yancey KB, Lawley TJ. Immunologically mediated skin diseases. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=9098448. Accessed January 10, 2012.
2. Costner MI, Sontheimer RD. Lupus erythematosus. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, eds. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw-Hill; 2008. http://www.accessmedicine. com/content.aspx?aID=2991998. Accessed January 10, 2012.
3. Hahn BH. Systemic lupus erythematosus. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012. http://www.accessmedicine.com/content. aspx?aID=9136499. Accessed January 10, 2012.
4. Mayeaux E Jr. Lupus erythematosus (systemic and cutaneous). In: Usatine RP, Smith MA, Chumley H, Mayeaux E Jr, Tysinger J, eds. The Color Atlas of Family Medicine. New York: McGraw-Hill; 2009. http://www.accessmedicine.com/content. aspx?aID=8208514. Accessed January 10, 2012.
5. Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum. 2008;58(1):15-25.
6. Cervera R, Khamashta MA, Font J, et al. Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. Medicine. 1993;72(2):113-124.
7. Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol. 2010;5(11):2060-2068.

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