Systemic Lupus Erythematosus: A Primer for Managed Care

ally 4 different kinds of lupus, of which SLE is the most common form. In addition to SLE, there is discoid lupus erythematosus, drug-induced lupus erythematosus, and neonatal lupus. Discoid, or cutaneous, lupus is limited to the skin, where it manifests as a variety of different rashes.1 Drug-induced lupus, which appears similar to SLE, usually dissipates within several weeks of discontinuation of the drugs that caused it.2,3 Neonatal lupus is quite rare, and is caused by a mother’s antibodies being passed on to the fetus. SLE is usually what is referred to when the word “lupus” is used.4 SLE is a rare autoimmune disease. In 2008, it has been estimated that between 161,000 and 322,000 American adults had SLE.5 Most of these adults are women in their childbearing years. The Euro Lupus Project analyzed 1000 patients with SLE; 91% were women, and the mean age at the onset of symptoms was 29 years (Figure 1).6 The impact of SLE on pregnancies can be severe. A meta-analysis calculated that 16% of pregnancies in women with SLE resulted in spontaneous abortion and 6.1% resulted in stillbirth or neonatal death. Overall, nearly a quarter of all pregnancies were unsuccessful in women with SLE and 39% of births were premature.7