Lupus is an unpredictable, multi-organ disease, and in some it may have milder course characterized by skin rashes or muscular aches, while in others it may start abruptly with predominant symptoms of some serious illness. It is not uncommon for lupus patients to present with the symptoms of kidney failure in the disease, especially those with an early onset. The condition is irregular in course: after the remission of the acute phase, things may get unpredictable again.
Long-term complications of lupus may look entirely different from the short term issues.
Long-term health problems in lupus
Disappointingly, little progress has been made in the last fifty years since finding the specific treatment of lupus, with very few newer drugs seeing the light. However, on the brighter side, the long-term prognosis of most people living with lupus has improved a lot, mostly thanks to the progress in other branches of medicine.
Nowadays, chances of long-term survival with lupus are much higher when compared to forty or fifty years back. Though a shortened lifespan still characterizes lupus, the research in the US and Europe shows that after 5 years the survival rate is between 90-95%, while after ten years it is above 80% and 76% after 15 years, further decreasing to about 65-70% after 20 years. It is much better if we compare the picture with the 1980's when 5-year survival was around 80% and just only 60% of patients were expected to survive after ten years (1).
Prognosis remains the worst among those presenting lupus with kidney disease, though lots have improved in that direction too.
So the question arises: what kills the people living with lupus?
Though the survival rate has improved, there is still a weak immune system caused by various factors that lead to infections remain that is considered the primary cause of death among people living with lupus. Infections remain the major problem both in the acute phase and in the long term. However, in those who have survived the first five years, complications of the cardiovascular system remain the primary cause of death.
But what about the quality of life? After all, survival is not the only thing about any disease condition.
Short-term survival may be the most important thing, but long-term is equally important. People who have lupus continue to suffer due to the accumulation of chronic damage to various organ systems. This constant suffering may reduce the quality of life. Many of these lasting changes are non-reversible and thus cannot be relieved.
In the long-term, patients surviving cardiovascular complications remain a primary concern, as these complications not only lead to higher disability or mortality due to diseases of the heart, but are the reasons behind the neuropsychiatric issues.
Heart diseases in those living with lupus
Lupus can cause disorders in all three layers of heart, which are the outer covering (pericarditis), middle muscular layer, or inner lining (endocarditis). The ailment of the outer fibrous covering of the heart is most common, and it is found even in those presenting with minimal symptoms.
Since the outer covering of the heart is not involved in its pumping function, it would not lead to mortality, but would instead be presented as a painful condition, whereas diseases of the muscular middle layer would more often lead to death.
Diseases of the inner layer of the heart (endocarditis) often remains undiagnosed, yet it is commonly present in those who have lupus and may lead to various complications.
Lupus is also characterized by malfunctioning of heart valves, which could be chronic changes leading to arrhythmia (irregular rhythm of the heart).
Vascular complications of lupus are widespread, mainly occurring due to the deposition of the complex immune system. Thus, blood vessels of just any organ that may get implicated., which is why thrombosis is a big problem in lupus.
Studies have demonstrated that a person living with lupus is at a higher risk of developing any heart disease. Moreover, these complications happen at a much younger age as compared to the general population (2).
Findings of the latest study
Recently a study was published in The Journal of Rheumatology that looked into the long-term cardiovascular complications of lupus. It was the study that explicitly sought to clarify the risk of heart-related complications in those who have survived the first eight years.
The study was primarily done on 210 women. It sought to find out the difference between the cardiac health of those living with lupus and healthy women of the same age. For comparison purposes, they also studied 138 healthy women. It was a study done for 15 years, and the results were reported with the follow-up period between 8 to 15 years. They analyzed the risk of heart diseases like angina pectoralis, myocardial infarction (both fatal and non-fatal), transient or mini heart attack, and stroke (both fatal and non-fatal).
The follow-up study found that cardiovascular problems in those living with lupus were three times higher as compared to the healthy population of the same age. Almost 20% of those followed for 8-15 years had a cardiac event, whereas in healthy people of a similar age incidence was only 6.5%. The most common heart issue in those with lupus was coronary artery disease (disease of blood vessels of the heart),although the risk of stroke was not much higher in those living with lupus.
The study also showed that during first eight years, risk of heart disease due to lupus is very high as compared to the conditions like diabetes or hypertension. But in long-term, that is after the eight years such risk decreased.
Finally, during the follow-up study, 31 patients with lupus died (10 of them due to heart disease), while in the non-lupus group 6 women died, but none due to heart disease. The study demonstrated not only the higher risk of the death rate in lupus, but also the importance of better cardiac care in the group.
The study concluded that those living with lupus are at a higher risk of developing heart disease, not only during the first eight years but also in the long term, though the reasons behind the higher rate of heart disease, in the long run, may differ. The long-term complications may also occur due to the side effects of drugs like corticosteroids (3).
1. Gordon C. Long-term complications of systemic lupus erythematosus. Rheumatology. 2002;41(10):1095-1100. doi:10.1093/rheumatology/41.10.1095.
2. Ansari A, Larson PH, Bates HD. Cardiovascular manifestations of systemic lupus erythematosus: current perspective. Prog Cardiovasc Dis. 1985;27(6):421-434.
3. Tselios K, Gladman DD, Su J, Ace O, Urowitz MB. Evolution of Risk Factors for Atherosclerotic Cardiovascular Events in Systemic Lupus Erythematosus: A Longterm Prospective Study. J Rheumatol. November 2017:jrheum.161121. doi:10.3899/jrheum.161121.