Prevalence of Physician-Diagnosed Systemic Lupus Erythematosus in the United States: Results from the Third National Health and Nutrition Examination Survey
29 Sep 2004-Journal of Womens Health (Mary Ann Liebert, Inc. 2 Madison Avenue Larchmont, NY 10538 USA)-Vol. 13, Iss: 6, pp 713-718
TL;DR: The prevalence of physician-diagnosed systemic lupus erythematosus in a national population-based sample in the United States using data from the Third National Health and Nutrition Examination Survey was 241 per 100,000 (95% confidence interval [CI] 130-352).
Abstract: Objective: To determine the prevalence of physician-diagnosed systemic lupus erythematosus (SLE) in a national population-based sample in the United States. Methods: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used to estimate the prevalence of self-reported physician-diagnosed SLE. Adult participants (age ≥ 17; sample n = 20,050) were asked if they had been diagnosed with SLE by a physician. All medications currently being taken by survey participants were recorded. Two definitions were used to classify participants with SLE: self-reported physician diagnosis and self-reported physician diagnosis and a current prescription for antimalarials, corticosteroids, or other immunosuppressive medications. Results: The prevalence of SLE in adults age ≥$ 17 based on self-reported physician diagnosis was 241 per 100,000 (95% confidence interval [CI] 130-352). The prevalence of SLE in adults age ≥ 17 based on self-reported physician diagnosis and current prescription for an...
Citations
More filters
TL;DR: This report provides the best available prevalence estimates for the US for osteoarthritis, polymyalgia rheumatica, gout, fibromyalgia, and carpal tunnel syndrome as well as the symptoms of neck and back pain.
Abstract: Objective
To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.
4,813 citations
Cites background from "Prevalence of Physician-Diagnosed S..."
...6 per 100,000 among adults age 18 years and 100 per 100,000 among adult women, based on self-reported physician diagnosis and current prescription of medications used for SLE treatment (69)....
[...]
TL;DR: Systemic lupus erythematosus is a relapsing and remitting disease, and treatment aims are threefold: managing acute periods of potentially life-threatening ill health, minimizing the risk of flares during periods of relative stability, and controlling the less life- threatening, but often incapacitating day to day symptoms.
Abstract: Systemic lupus erythematosus (SLE) is a clinically heterogeneous disease, which is autoimmune in origin and is characterized by the presence of autoantibodies directed against nuclear antigens. It is a multi-system disease, and patients can present in vastly different ways. Prevalence varies with ethnicity, but is estimated to be about 1 per 1000 overall with a female to male ratio of 10:1. The clinical heterogeneity of this disease mirrors its complex aetiopathogenesis, which highlights the importance of genetic factors and individual susceptibility to environmental factors. SLE can affect every organ in the body. The most common manifestations include rash, arthritis and fatigue. At the more severe end of the spectrum, SLE can cause nephritis, neurological problems, anaemia and thrombocytopaenia. Over 90% of patients with SLE have positive anti-nuclear antibodies (ANA). Significant titres are accepted to be of 1:80 or greater. SLE is a relapsing and remitting disease, and treatment aims are threefold: managing acute periods of potentially life-threatening ill health, minimizing the risk of flares during periods of relative stability, and controlling the less life-threatening, but often incapacitating day to day symptoms. Hydroxychloroquine and non-steroidal anti-inflammatory drugs are used for milder disease; corticosteroids and immunosuppressive therapies are generally reserved for major organ involvement; anti-CD20 monoclonal antibody is now used in patients with severe disease who has not responded to conventional treatments. Despite enormous improvements in prognosis since the introduction of corticosteroids and immunosuppressive drugs, SLE continues to have a significant impact on the mortality and morbidity of those affected.
4,376 citations
Cites background from "Prevalence of Physician-Diagnosed S..."
...Data from a national health survey in the USA found the self-reported prevalence of SLE (defined as having been given a diagnosis of SLE by a physician) to be 241/100,000 [5]....
[...]
22 Jan 2008
TL;DR: In this paper, the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain are provided.
Abstract: OBJECTIVE
To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.
METHODS
The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition.
RESULTS
We estimated that among US adults, nearly 27 million have clinical osteoarthritis (up from the estimate of 21 million for 1995), 711,000 have polymyalgia rheumatica, 228,000 have giant cell arteritis, up to 3.0 million have had self-reported gout in the past year (up from the estimate of 2.1 million for 1995), 5.0 million have fibromyalgia, 4-10 million have carpal tunnel syndrome, 59 million have had low back pain in the past 3 months, and 30.1 million have had neck pain in the past 3 months.
CONCLUSION
Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions more studies generalizable to the US or addressing understudied populations are needed.
4,355 citations
TL;DR: Data on SLE incidence and prevalence in the USA, Europe, Asia, and Australia over the period of 1950-early 2006 is summarized to clarify the role of genetic, environmental and other causative factors in the natural history of the disease, and to understand its clinical and societal consequences.
Abstract: Systemic lupus erythematosus (SLE) is a disease of multifactorial etiology. Quantifying the burden of SLE across different countries can clarify the role of genetic, environmental and other causative factors in the natural history of the disease, and to understand its clinical and societal consequences. The aim of this study is to summarize data on SLE incidence and prevalence in the USA, Europe, Asia, and Australia. An extensive review of electronic resources (PubMed and MedLine) and medical journals was conducted to identify published studies on SLE incidence and prevalence over the period of 1950-early 2006. Researchers in the countries of interest provided additional information on the epidemiology of SLE. The incidence and prevalence of SLE varies considerably across the countries. The burden of the disease is considerably elevated among non-white racial groups. There is a trend towards higher incidence and prevalence of SLE in Europe and Australia compared to the U.S.A. In Europe, the highest prevalence was reported in Sweden, Iceland and Spain. There are marked disparities in SLE rates worldwide. This variability may reflect true differences across populations, or result from methodological differences of studies. The true geographic, racial, and temporal differences in SLE incidence and prevalence may yield important clues to the etiology of disease.
771 citations
TL;DR: The understanding of ways to improve outcomes in SLE patients could benefit from patient-oriented research focusing on many dimensions of disease burden, and promising research initiatives include the inclusion of community-based patients in longitudinal studies, and use of self-assessment tools for rating disease damage and activity.
761 citations
Cites background from "Prevalence of Physician-Diagnosed S..."
...Studies relying on self-report of an SLE diagnosis, without review of symptom history or medical records, have reported higher prevalence rates (39,40)....
[...]
References
More filters
TL;DR: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification and showed gains in sensitivity and specificity.
Abstract: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included in the 1982 revised criteria because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity.
14,272 citations
Centers for Disease Control and Prevention1, University of Texas Health Science Center at Houston2, University of Washington3, Boston University4, Boston Children's Hospital5, National Institutes of Health6, University of Maryland, Baltimore7, Mayo Clinic8, Brigham and Women's Hospital9, Georgetown University Medical Center10
TL;DR: Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.
Abstract: Objective
To provide a single source for the best available estimates of the national prevalence of arthritis in general and of selected musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, the spondylarthropathies, systemic lupus erythematosus, scleroderma, polymyalgia rheumatica/giant cell arteritis, gout, fibromyalgia, and low back pain).
Methods
The National Arthritis Data Workgroup reviewed data from available surveys, such as the National Health and Nutrition Examination Survey series. For overall national estimates, we used surveys based on representative samples. Because data based on national population samples are unavailable for most specific musculoskeletal conditions, we derived data from various smaller survey samples from defined populations. Prevalence estimates from these surveys were linked to 1990 US Bureau of the Census population data to calculate national estimates. We also estimated the expected frequency of arthritis in the year 2020.
Results
Current national estimates are provided, with important caveats regarding their interpretation, for self-reported arthritis and selected conditions. An estimated 15% (40 million) of Americans had some form or arthritis in 1995. By the year 2020, an estimated 18.2% (59.4 million) will be affected.
Conclusion
Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.
2,667 citations
TL;DR: After reviewing the medical literature for incidence and prevalence rates of 24 autoimmune diseases, it is concluded that many autoimmune diseases are infrequently studied by epidemiologists and the total burden of disease may be an underestimate.
1,519 citations
TL;DR: Over the past 4 decades, the incidence of SLE has nearly tripled, and there has been a statistically significant improvement in survival.
Abstract: Objective
To describe trends in systemic lupus erythematosus (SLE) incidence and mortality over the past 4 decades.
Methods
Using the Rochester Epidemiology Project resources, medical records were screened to identify all Rochester, Minnesota residents with any SLE-associated diagnoses, discoid lupus, positivity for antinuclear antibodies, and/or false-positive syphilis test results determined between January 1, 1980 and December 31, 1992. Medical records were then reviewed using a pretested data collection form in order to identify cases of SLE according to the American College of Rheumatology 1982 revised criteria for SLE. Drug-induced cases were excluded. All identified SLE patients were followed up until death, migration from the county, or October 1, 1997. These data were combined with similar data from the same community obtained between 1950 and 1979, and trends in the SLE incidence and mortality over time were calculated.
Results
Of the 430 medical records reviewed, 48 newly diagnosed cases of SLE (42 women and 6 men) were identified between 1980 and 1992. The average incidence rate (age- and sex-adjusted to the 1970 US white population) was 5.56 per 100,000 (95% confidence interval [95% CI] 3.93–7.19), compared with an incidence of 1.51 (95% CI 0.85–2.17) in the 1950–1979 cohort. The age- and sex-adjusted prevalence rate as of January 1, 1993 was ∼1.22 per 1,000 (95% CI 0.97–1.47). Survival among SLE patients was significantly worse than in the general population (P = 0.017 compared with the 1980–1992 cohort, and P < 0.0001 compared with the 1950–1979 cohort, by log-rank test). Cox proportional hazards modeling demonstrated a statistically significant improvement in the survival rate over time (P = 0.035).
Conclusion
Over the past 4 decades, the incidence of SLE has nearly tripled, and there has been a statistically significant improvement in survival. These findings are likely due to a combination of improved recognition of mild disease and better approaches to therapy.
480 citations
TL;DR: The authors' rates clearly confirm previous reports of an excess incidence of SLE among females compared with males and among African-Americans compared with whites, and advocate their use to facilitate comparisons across studies.
Abstract: Objective. To examine racial differences in the incidence of systemic lupus erythematosus (SLE).
Methods. A population-based registry of SLE patients in Allegheny County, Pennsylvania, was used to identify incident cases of SLE diagnosed between January 1, 1985 and December 31, 1990, from 3 sources, by medical record review (University of Pittsburgh Lupus Databank, rheumatologists, and hospitals). Capture-recapture methods using log-linear models were used to estimate the level of case-finding and to calculate 95% confidence intervals (CI). Incidence rates were calculated per 100,000 population.
Results. A total of 191 definite and 78 probable incident cases of SLE were identified, and the overall annual incidence rates were 2.4 (95% CI 2.1–2.8) and 1.0 (95% CI 0.8–1.3), respectively. The crude incidence rates of definite SLE were 0.4 for white males, 3.5 for white females, 0.7 for African-American males, and 9.2 for African-American females. The annual incidence rates of definite SLE remained fairly constant over the study interval. African-American females with definite SLE had a younger mean age at diagnosis compared with white females (P < 0.05). Since the overall ascertainment rate was high (85%; 95% CI 78–92%), the ascertainment-corrected incidence rate for definite SLE, 2.8 (95% CI 2.6–3.2), was similar to the crude rate.
Conclusion. Our rates clearly confirm previous reports of an excess incidence of SLE among females compared with males and among African-Americans compared with whites. We have used capture–recapture methods to improve the accuracy of SLE incidence rates, and we advocate their use to facilitate comparisons across studies.
410 citations