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Lupus Death Rate Jumps 35 Percent

5/2/2002      

THURSDAY, May 2 (HealthScoutNews) -- Government health officials are concerned about a sharp increase in deaths from an unusual form of arthritis known as lupus.

The death rate from systemic lupus erythematosus (SLE) increased by 35 percent over two decades, according to the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention. The increase was greatest among one group of people -- middle-aged black women, among whom the death toll rose by almost 70 percent.

Like most other things about SLE, that increase has no clear explanation, says Dr. Charles Helmick, an arthritis expert with the CDC.

"There is a clear disparity in how those deaths occur, and we don't have enough data to know what to make of it," Helmick says.

The numbers are relatively small -- 22,861 deaths from SLE between 1979 and 1998, with 1,406 deaths in 1998 -- but SLE is being highlighted because "you do get premature death from this kind of arthritis," Helmick says.

SLE is an autoimmune disease in which the immune system begins to attack not only the joints, but also organs that include the kidneys and the heart. Its toll differs by both race and sex; the death rate is more than five times higher for women than for men, and three times higher for blacks than whites.

Even the incidence of SLE is something of a mystery, Helmick says. Estimates vary greatly, ranging as high as 4 million cases in the United States.

One cause of uncertainty is that the early symptoms of the disease are vague enough for it to be confused with other medical problems or dismissed as minor -- fatigue, chest pains, occasional lung problems and sometimes swollen glands.

"People are walking around with these early symptoms, and they don't recognize it as a serious problem," Helmick says.

Early diagnosis can help because there are effective treatments for the disease, Helmick says, but he acknowledges those treatments often "aren't easy to undergo" because of their side effects.

For example, one drug used to treat SLE is prednisone, which can cause weight loss and thinning of the bones. Anticancer drugs such as methotrexate can be used; all the medications suppress the immune system activity that causes inflammation.

The CDC is considering the establishment of a special registry to help solve some of the puzzles about SLE, Helmick says. The registry would focus on one specific region of the country, giving detailed information on as many cases as possible. That might help determine whether the increased death toll is real or comes from better recognition of the condition.

Planning for a registry is in its early stages, and it could be two or three years before it is funded, Helmick says.

Meanwhile, the CDC is urging public awareness that would help in diagnosing the condition early. SLE often starts early, and can interfere with fertility in younger women, Helmick says.

Meanwhile, the Lupus Foundation has asked Congress to "provide medical services to poor and uninsured people with lupus…."

What To Do

In addition to fatigue and other problems, one classic symptom of SLE that should prompt a visit to a doctor is "a butterfly rash over the nose and cheeks," Helmick says.

Detailed information about SLE is offered by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Here is the press release from the Lupus Foundation that reacts to the CDC report.

SOURCES: Charles Helmick, M.D., arthritis expert, Centers for Disease Control and Prevention; May 3, 2002, Morbidity and Mortality Weekly Report

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