Treatment and Mortality

In the 1940s it was generally acknowledged that there was no effective treatment for either DLE or SLE. The initial breakthrough occurred in 1949, with the discovery that the corticosteroids cortisone and corticotropin can exert a dramatic suppression of most symptoms of SLE. Prednisone, a synthetic derivative of cortisone, was introduced in 1955 and has become the most commonly used orally administered corticosteroid (Urman and Rothfield 1977). Only the cutaneous and renal manifestations are frequently refractory. In 1951, quinacrine, an antimalarial drug, was found to be effective against DLE. Soon thereafter, the antimalarials chloroquine and hydroxychloroquine were found similarly useful, and the latter is now principally employed. In SLE the antimalarials are also most effective against the rash, but they may also ameliorate some visceral symptoms. The third major therapeutic category is the immunosuppressive drugs. The first to be tried was nitrogen mustard, in 1950. Now the most commonly used drugs in this category are azathio-prine and cyclophosphamide (Wagner 1976). This type of treatment is reserved for severe renal involvement and refractoriness to corticosteroid therapy.

Modern therapy has not only improved the quality of life of the SLE patient but has also greatly prolonged his or her survival. Before the advent of corticosteroids, one-half of these patients died within 2 to 3 years of being diagnosed. Now the mean survival of 15 years after diagnosis has reached 75 percent. Two factors in addition to the therapeutic agents cited above help to account for this improvement: (1) better antibiotic therapy for potentially fatal bacterial infections; and (2) recognition of much milder cases for which a more benign course is likely even with minimal therapy.

Mortality is influenced by race and sex. According to U.S. data for 1968 to 1976, the annual mortality rate, relative to 1.0 for white males, was 1.6 for black males; 3.7 for white females; and 10.5 for black females (Gordon, Stolley, and Schinar 1981).

Your Heart and Nutrition

Your Heart and Nutrition

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