R. Murali et al., SYSTEMIC LUPUS-ERYTHEMATOSUS IN INDIAN PATIENTS - PROGNOSIS, SURVIVALAND LIFE EXPECTANCY, National Medical Journal of India, 10(4), 1997, pp. 159-164
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.