SYSTEMIC LUPUS-ERYTHEMATOSUS IN INDIAN PATIENTS - PROGNOSIS, SURVIVALAND LIFE EXPECTANCY

Background. There have been several studies on survival patterns in In dian patients with systemic lupus erythematosus but it is still not cl ear as to which factors at diagnosis predict survival outcome. The imp act of specific organ involvement, and of disease activity itself, nee ds to be studied further. Methods. We conducted a non-concurrent prosp ective study of 98 lupus patients between 1981 and 1993. The clinical symptoms, signs and investigation results at onset, and at subsequent visits, were abstracted from the case notes. A system ic lupus erythem atosus disease activity index (SLEDAI) was constructed at the initial presentation and for each subsequent visit. Patients not attending for at least 6 months were traced by post. The quantitative data from the SLEDAI was used to construct a Markov chain mathematical expression d esigned to predict life expectancy. Results. The cumulative percentage survival at 1,5 and 10 years was found to be 89%, 77% and 60%, respec tively. The Markov chain predicted a life expectancy of 13.9 years. Ce ntral nervous system and renal involvement were poor prognostic factor s. Proteinuria (>0.5 g/day) caused a 50% reduction in life expectancy but increased disease activity at onset did not predispose to a poor o utcome. Conclusion. The survival of patients with systemic lupus eryth ematosus continues to be poor. Central nervous system and renal diseas e indicate a poor outcome. Hence, new treatment strategies must be evo lved to improve the survival of such patients.