Prognosis and duration
General
- Modern treatment, better clinical awareness and improved serological testing techniques have dramatically improved survival.
- However, 10% of lupus patients die within 5 years of diagnosis. Even moderate disease should be under the care of a Specialist centre. The disease should never be “taken for granted”, as there is a risk of major organ effects and death.
- Also, inevitably, there are people who suffer serious side effects from the treatment, which can complicate symptoms, and in rare cases, lead to death. An example is the use of steroids which can lead to hypertension, diabetes, hypercholesterolaemia, or osteoporosis (18% have the metabolic syndrome). A person who is on long- term immunosuppressive treatment may succumb to an overwhelming infection. However, the treatment is always aimed at controlling the underlying inflammation and minimising risks from the treatment.
- The disease is relapsing and remitting, in both mild and severe cases.
- Prognosis has improved greatly in the last few years; and 5 – year survival is now around 90%.
- Good control of early inflammatory symptoms leads to a better long- term prognosis.
- Long – term prognosis also depends on early detection and treatment of complications, such as kidney disease.
- The main cause of death is accelerated atherosclerosis and kidney disease. The prophylactic prevention and management of cardiovascular risk is very important in improving the person’s prognosis.
If any of the following complications are present, the prognosis & duration details for that impairment should be referred to and followed.
Specific
Musculo-skeletal complications:
- Jaccoud’s Arthropathy is not likely to improve.
A person who has avascular necrosis of the hip may have a total hip replacement, in which case this particular condition is likely to improve.
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Skin complications:
- Scarring of the scalp and hair loss can be permanent.
- Persistent Raynaud’s Disease can be a permanent problem, but it may improve if amenable to treatment, such as Nifedipine. More severe and unresponsive cases may require more specialist intervention.
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Mental Health and Central Nervous System Complications
Symptoms may fluctuate, and the symptoms may range from
- Mild to severe effects such as mild depression to severe psychosis and
- Either a mental health effect (ranging from depression to psychosis), or a
central nervous effect, such as epilepsy, ataxia, neuropathy or hemiplegia for example.
Kidney Complications
Clinical kidney involvement occurs in around 30% of cases and affects prognosis. Kidney disease is one of the two main causes of death in lupus.
The person may be in renal failure, requiring dialysis or a transplant and prognosis will depend on the treatment and response to that treatment.
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Cardiovascular complications
Accelerated atherosclerosis is the other main cause of death in SLE. Good preventative measures must be implemented in order to improve prognosis.
Arrythmias (irregular heartbeat) may arise as a result of a mild myocarditis.
Thromboembolic disease is another complication, especially in the antiphospholipid syndrome.
Prognosis would relate to the presence of these conditions, the efficacy of treatment and the individuals stopping smoking.
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Lung Complications
Repeated episodes of pleurisy and pleural effusions can be treated and the prognosis will relate to the response to treatment and the length of time it takes.
Restrictive lung disease and lung fibrosis will gradually worsen and the effects are permanent.
All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.
Amended November 2008
