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Improving Outcomes in Systemic Lupus Erythematosus: Latest Advances and Prospects in Relation to Comorbidity, Damage, and Quality of Life

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Dr. Oshrat E. Tayer-Shifman

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Guest Editor

1. Rheumatology Unit, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 4428164, Israel
2. Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
Interests: systemic lupus erythematosus; systemic autoimmune rheumatic diseases; lupus nephritis; cognitive impairment; comorbidities

Dr. Shaye Kivity

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Guest Editor

Special Issue Information

Dear Colleagues,

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which long-term outcomes are determined not only based on disease activity but also based on comorbidities, treatment burden, and cumulative organ damage. Despite therapeutic advances, patients continue to face major challenges, including cardiovascular disease, infection risk, and impaired quality of life. Mood disturbances, cognitive impairment, and fatigue are critical areas that patients often feel are overlooked in routine rheumatology care. Although treat-to-target strategies are emerging, they are not yet fully incorporating patient perspectives.

This Special Issue will highlight the latest advances and future prospects in improving outcomes and quality of life for people living with SLE. We welcome contributions exploring comorbidity prevention, damage accrual, infection risk and vaccination, and patient-reported outcomes. Submissions focusing on biomarkers, digital monitoring, steroid-sparing strategies, and treat-to-target approaches are also encouraged. By emphasizing outcomes that matter to both patients and clinicians, this Special Issue will inform best practice and define priorities for future research and care in SLE.

Dr. Oshrat E. Tayer-Shifman
Dr. Shaye Kivity
Guest Editors

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17 pages, 748 KB

Open AccessArticle

Ethnic Disparities in Achieving Treatment Targets and Organ Damage Accrual in Systemic Lupus Erythematosus: A Multi-Centre Study from Malaysia

by Syahrul Sazliyana Shaharir, Teh Cheng Lay, Asmahan Mohamed Ismail, Azwarina Hanim Ramlan, Tan Chou Luan, Hairul Hadi Ariff, Anna Farazilah Mohd Salleh, Ng Chun Ruh, Asmah Mohd, Chua Siew Houy, Nadiah Mohd Noor, Ling Guo Ruey, Sharifah Aishah Wan Mohamad Akbar, Raja Jasmin Begum Raja Mohamed, Fariz Yahya, Kan Sow Lai, Wan Syamimee Wan Ghazali, Shakira Selvananda, Dayang Masyrinartie Suhaili, Noraini Mat Husin, Hashimah Abu Mansor Matardiah, Eashwary Mageswaran, Suhaida Ahmad Maulana, Mariam Hamid Mustapha, Wan Rosmaiza Wan Musa, Nor Shuhaila Shahril, Liza Mohd Isa, Shereen Ch’ng Suyin, Norliza Zainudin, Mollyza Mohd Zain, Habibah Mohd Yusoof, Chong Hwee Cheng, Hong Hooi Chuen, Jasmine Yew Sze Yin, Siti Mariam Ab Rahim, Lim Shiau Li, Gan Syang Pyng, Hazlyna Baharuddin, Nur Farhana Abdul Manaf, Malehah Mohd Noh, Sakthiswary Rajalingham, Mohd Shahrir Mohamed Said, Rozita Mohd and Muhammad Irfan Abdul Jalal Show full author list Hide full author list

J. Clin. Med. 2026, 15(9), 3387; https://doi.org/10.3390/jcm15093387 - 29 Apr 2026

Abstract

Background/Objectives: Systemic lupus erythematosus (SLE) is a heterogeneous disease with substantial variability in clinical manifestations and outcomes, influenced by ethnic and geographical diversity. Remission is the optimal treatment target, while low lupus disease activity state is an accepted alternative goal. Although sustained remission has been associated with reduced organ damage, the impact of early attainment of treatment targets on subsequent damage accrual in SLE remains incompletely defined. To explore a potential window of opportunity, this study aimed to identify factors associated with achieving remission or low lupus disease activity state within the first year of SLE diagnosis and to examine their associations with organ damage. Methods: This retrospective study was conducted across 22 rheumatology centres in Malaysia and included patients with systemic lupus erythematosus (SLE) who had complete follow-up from diagnosis until attainment of treatment targets. Treatment targets were defined as achieving either early remission or a low disease activity state (LDAS). Given the retrospective nature of the study and the unavailability of complete Physician’s Global Assessment data, the definitions of early remission and LDAS were modified by excluding this component. Accordingly, treatment targets were defined as attainment of a clinical SLE Disease Activity Index (cSLEDAI) score of 0 with oral prednisolone doses of ≤5 mg/day and ≤7.5 mg/day, respectively, within 12 months of SLE onset. Multivariable Cox proportional hazards regression and logistic regression analyses were performed to determine factors associated with early remission and organ damage, respectively. Results: A total of 1599 patients were included, the majority of whom were female (92.5%). The cohort was predominantly Malay (68.7%), followed by Chinese (17.4%), Indigenous groups (10.8%) and Indian (3.0%). Early attainment of treatment targets was achieved in 45.7% of patients, while 54.3% experienced delayed attainment. In the multivariable cox regression model, the Malay and Chinese ethnic group demonstrated a significantly lower likelihood of achieving early remission compared to the Indigenous ethnic group. Patients with longer SLE duration, low C4 levels, presence of haematological and renal manifestations at the initial presentation, were identified as additional adverse factors associated with lower likelihood of early remission. Overall, 16.9% of patients accrued organ damage. Independent factors associated with organ damage included Indian ethnicity [OR 5.75, 95% CI 1.39–23.81, p = 0.02], delayed remission [OR 2.97, 95% CI 1.51–5.83) and absence of baseline hydroxychloroquine therapy [OR 4.13, 95% CI 1.21–14.07; p = 0.020]. Conclusions: Ethnic disparities were observed in the early attainment of the treatment targets, as well as in organ damage accrual within the Malaysian multi-ethnic SLE cohort. The significant association between the delay in achieving the treatment targets and organ damage underscores the importance of adopting an early treat-to-target approach in SLE management. Full article

(This article belongs to the Special Issue Improving Outcomes in Systemic Lupus Erythematosus: Latest Advances and Prospects in Relation to Comorbidity, Damage, and Quality of Life)

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