Risk of Mortality from SLE
By Ansaam Daoud, MD, Loai Dweik, MD, & Omer Pamuk, MD
Why was this study done? Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant mortality, particularly affecting racial and ethnic minorities. This study aimed to assess national SLE mortality trends over the past two decades, stratified by sex, race, ethnicity and geography, using U.S. Centers for Disease Control and Prevention (CDC) mortality data.
What were the study methods? Using the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database, the researchers analyzed SLE-related deaths from 1999 to 2020. Age-adjusted mortality rates (AAMRS) were calculated for sex, race, ethnicity and state. Linear regression models were applied to assess trends over time, and geographic mortality distributions were mapped. Joinpoint regression analysis was performed to detect significant shifts in mortality trends over time.
What were the key findings? From 1999 to 2020, 27,213 SLE-related deaths were recorded in the U.S. Women had a significantly higher AAMR (6.21 per million; 95% confidence interval [CI] 6.13-6.29) than men (1.20 per million; 95% CI 1.16-1.24). Black Americans experienced the highest AAMR (10.7 per million; 95% CI 10.48-10.92), particularly Black women (17.68 per million; 95% CI 17.29- 18.06). Despite an overall decline in SLE mortality ($R^2=0.902$), racial and regional disparities persisted, with mortality disproportionately concentrated in Southern states and among Black women.
Notably, the Hispanic population, which had a higher AAMR than non-Hispanic populations in 1999, demonstrated significant improvements in mortality outcomes over time. By 2020, that group’s AAMR had declined to a level lower than that of the non-Hispanic population.
What were the main conclusions? Over the past two decades, SLE-related mortality has steadily declined across all demographic groups. However, Black Americans especially women-continue to experience disproportionately high mortality rates. Additionally, Southern states have higher SLE mortality than other regions. Encouragingly, the Hispanic population saw a notable improvement in mortality rates over time, surpassing non-Hispanic groups in reduced AAMR.
What are the implications for patients and clinicians? Despite advances in SLE management, significant racial and regional disparities in mortality persist. Further studies are needed to understand the underlying mechanisms contributing to the disproportionately increased SLE mortality rates. Meanwhile, the positive trend in the Hispanic population highlights the potential benefits of improved healthcare access and disease management strategies, warranting further investigation into the contributing factors.
The study: Daoud A, Dweik L., Pamuk O. Temporal trends and demographic insights into mortality from systemic lupus erythematosus, 1999-2020. Arthritis Care Res (Hoboken). 2025. Early view.
Heart Failure & RA
By Yumeko Kawano, MD, & Katherine P. Liao, MD, MPH
Why was this study done? Heart failure (HF) is the leading cause of hospitalization among individuals older than 65, with a growing number of patients diagnosed with a subtype called HF with preserved ejection fraction (HFpEF). HF subtypes have direct clinical implications for the screening and treatment of patients; however, data on these subtypes in patients with rheumatoid arthritis (RA) are limited. This study compared the risk of HF and HF subtypes among patients with RA compared with those without RA.
What were the study methods? Patients with RA and non-RA comparators were identified among participants enrolled in a research biobank from two large academic centers with linked electronic health records (EHRs). We applied validated machine-learning and natural language processing methods to further identify individuals with HF subtypes based on ejection fraction data. We then compared the risks of new-onset HF and HF subtypes in patients with and without RA. When comparing risk between the two groups, the models adjusted for known risk factors for HF, such as age, hypertension and diabetes.
What were the key findings? Among 1445 RA patients and 4,335 matched non-RA comparators, HFpEF was the most common HF subtype in both groups (65% in RA vs. 59% in non-RA). Patients with RA had an estimated 1.8x increased risk for HF compared to non-RA (hazard ratio [HR] 1.79, 95% CI 1.38-2.32) even after adjusting for known risk factors. When examined by HF subtypes, the risk for HFpEF was approximately 2x higher in RA compared to non-RA, (HR 1.99, 95% CI 1.43-2.77), while no statistical difference was observed in HFrEF risk.
What are the implications for patients and clinicians? In this study, we observed that RA was an independent risk factor for HF, particularly for HFPEF, representing 65% of all HF cases among patients with RA. Together with prior studies of RA demonstrating an association between inflammation and increased risk for HFpEF, these data suggest that tight control of inflammation early in the course of RA has the potential to modify the risk of HFpEF. Additionally, with the recent availability of therapies specific for HFpEF, recognizing this growing comorbidity in our patient population is important.
The study: Kawano Y, Weber BN, Weisenfeld D, et al. Risk of incident heart failure and heart failure subtypes in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2024 Dec 9. Epub ahead of print.
Walk with Ease
By Christine A. Pellegrini, PhD, et al.
Why was this study done? Many adults with arthritis face barriers to attending in-person physical activity programs; thus, we converted a traditional in-person walking program (the Arthritis Foundation’s Walk with Ease program) for telephone delivery and examined the effects of the telephone-delivered program on activity and arthritis-related outcomes over 12 months.
What were the study methods? Adults (n=267) who reported doctor-diagnosed arthritis were randomized to a telephone-based Walk with Ease program (WWE-T) or a control group. Participants in WWE-T received two telephone calls each week for six weeks. The first call each week was led by a WWE.certified leader, focused on education related to exercising with arthritis, and included between five and 17 other adults with arthritis. The second call was a one-on-one call with the WWE leader and focused on problem solving and goal setting. Outcomes were assessed at baseline, six weeks, and six and 12 months.
What were the key findings? Participants in WWE-T completed 82% of the calls, and 93% of participants were satisfied with the program. At six weeks, participants in WWE-T had greater improvements in physical function, fatigue, self-efficacy and activity impairment due to health than the control group. At six months, WWE-T led to improved function and self-efficacy and greater reductions in depression symptoms and activity impairment than the control group. At 12 months, physical activity was not significantly different across groups; however, participants in WWE-T had better physical function, higher arthritis self-efficacy, lower depression symptoms and lower impairment in daily activities than before the program started.
What were the main conclusions? A six-week telephone-delivered Walk with Ease program led to significant improvements in both short- and long-term arthritis-related outcomes. Specifically, improvements in physical function, self-efficacy and impairment in daily activities were seen over one year.
What are the implications for patients and clinicians? These results suggest that a remotely delivered telephone walking program may be an effective alternative for adults with arthritis who face barriers to attending in-person programs. Specifically, clinicians could recommend this phone-based walking program to inactive patients with arthritis who may not have the access, or the ability, to attend in-person community physical activity programs.
The study: Pellegrini CA, Wilcox S, Kim Y, et al. Effectiveness of a telephone-delivered walk with ease program on arthritis-related symptoms, function, and activity: A randomized trial. Arthritis Care Res (Hoboken). 2025 Mar 3. Epub ahead of print.
