Special issue on systemic lupus erythematosus in Asia.

Abstract

Systemic lupus erythematosus (SLE) is fairly common in Asians, with an overall crude incidence rates (per 100 000 population per year) ranging from 0.9 to 3.1 and crude prevalence rates ranging from 4.3 to 45.3 (per 100 000) in the Asia-Pacific countries.1 SLE is at least two to three times more prevalent in Asia than in the Caucasian countries. As the population in Asia is huge, the burden of SLE disease in the Asian Pacific region is considerable.2 SLE is a multi-systemic autoimmune disease that predominantly affects women of childbearing age. It is characterized by myriads of immunological aberrations that lead to inflammation, dysfunction and damage of multiple organ systems.3 The clinical course of SLE is highly variable and unpredictable, with periods of exacerbations and remissions. Immunosuppressive treatment in order to control SLE disease activity may also incur further complications to organ functions, leading to increased risk of mortality and morbidities such as pain, functional impairment, mood disorders and work disability. All these factors lead to a significant impairment in the quality of life.4 Despite the advancement in the diagnosis and treatment of SLE in the past few decades leading to the improvement in survival, the survival rates of SLE in various localities appear to be plateaued after the 1990s’, and the relative mortality of the disease as compared to the general population is still high.5 Treatment of refractory SLE manifestations is a challenge and more clinical and laboratory research is clearly necessary. The emergence and ongoing studies of the biological agents has added to the arsenal of treatment modalities for SLE. Early diagnosis and identification of disease flares by novel biomarkers, better monitoring of treatment adherence, efficacy and toxicities of immune-modulatory regimens will help to further improve the prognosis of this mysterious disease. In this issue of International Journal of Rheumatic Diseases, experts from different Asian Pacific countries were invited to summarize their views and research works on different aspects of SLE in Asian patients. Clinical topics include the epidemiology of SLE in different ethnic groups, childhood onset SLE, existing and emerging biological therapies for SLE, treatment of lupus nephritis in Asian patients, pregnancy issues of SLE, infective complications of SLE and research on the antiphospholipid antibody syndrome. In addition, basic scientific reviews on the pathogenesis of SLE, genetics, biomarkers in lupus nephritis, role of dendritic cells, lymphocyte subsets and the role of vitamin D and mesenchymal cells in SLE are also included. We hope this special issue of SLE in Asia will provide readers an overview of the works that are ongoing in the Asian Pacific region and an update on the clinical management of different aspects of the disease.