Accelerated Atherosclerosis in SLE: Mechanisms, Consequences, and Future Directions

The bimodal mortality rate in systemic lupus erythematosus (SLE) has been well documented, with atherosclerosis identified as a leading cause of late-stage death. Multiple mechanisms are responsible for accelerated atherosclerosis in SLE, ultimately resulting in endothelial dysfunction, arterial stiffness, arterial wall thickening, and plaque formation. This leads to an increased risk of coronary artery disease, cardiovascular events, cerebrovascular accidents, and peripheral arterial disease. SLE patients are not only impacted by traditional risk factors for cardiovascular disease (age, smoking, dyslipidemia, diabetes), but additionally nontraditional risk factors (prolonged corticosteroid use, disease activity and chronic inflammation). Identifying the impact of traditional risk factors and mediating nontraditional risk factors in SLE are vital to reduce morbidity and mortality related to atherosclerosis. SLE-specific screening methods should be established in the routine care of these patients, including the use of validated modified risk scores and imaging modalities. Furthermore, the utility of disease-specific biomarkers and anti-atherosclerotic therapies should be elicited. This chapter will provide an overview of considerations for the mechanisms, impact, and prevention of atherosclerosis in SLE patients

Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases.

BackgroundThe impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide.MethodsSurvey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis.Findings12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46·1 years; 8375 [90·1%] women, 893 [9·6%] men, and 32 [0·3%] participants who identified as non-binary). 6273 (67·5%) of respondents identified as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, and 42 (0·5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39·1%] of 9300), systemic lupus erythematosus (2882 [31·0%]), and Sjögren's syndrome (1290 [13·9%]). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99·7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27·1%) of 9300) of respondents, with a 13·6% decrease in the number in full-time employment (from 4066 to 3514).InterpretationPeople with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity.FundingAmerican College of Rheumatology