Although systemic lupus erythematosus still does not have a definite cause or cure, rheumatologists and researchers over the past 50 years have witnessed and contributed to a great deal of progress that helps patients, says Peter H. Schur, MD, director emeritus of the Lupus Center, Brigham and Women’s Hospital, and professor, Harvard Medical School, Boston.
Dr. Schur’s long career began after he attended Harvard Medical School and completed a residency in internal medicine at the Bronx Municipal Hospital Center, The Bronx, New York, in the early 1960s. Subsequently, he served in the U.S. Army (Medical Corps), doing research at the Walter Reed Army Institute of Research in Washington, D.C. During a fellowship at Rockefeller University in New York, Dr. Schur worked in the lab of Henry G. Kunkel, MD, a pioneer in immunological research. While there, Dr. Schur helped develop a complement assay to detect antibodies for DNA.
Dr. Schur has been at the helm of bench research related to lupus while also remaining a clinician. Among other career highlights, he has served as editor in chief of Arthritis & Rheumatism, editor of the rheumatology section of the medical resource UpToDate (a role he continues today), and co-author of the book In Search of the Sun with one of his patients. Dr. Schur also helped found the Lupus Foundation of America.
With this rich background, Dr. Schur was able to offer The Rheumatologist a unique perspective on some of the biggest milestones in lupus over the past 50 years.
Better Drugs & Survival—But Not a Perfect Scenario
Lupus may not have made the same drug-related advances that rheumatoid arthritis (RA) has, but there have been enough positive changes that survival rates have significantly improved in comparison to 50 years ago, Dr. Schur says. “If you look at survival statistics, in the late 1950s, there was a 50% chance of four-year survival. Now, 90% of lupus patients have a 10- to 20-year survival rate. That’s a whopping difference,” he says.
A proliferation of new drugs to treat lupus has not occurred over the past few decades, but corticosteroids have remained a steady part of the treatment mix. “The major trend I’ve seen is that less [steroids] may be better, but we’re still using pulse steroids,” he says. Corticosteroids remain a key part of treatment even though no randomized controlled trials exist to identify the optimal dose for patients with lupus. Although research has found an increased risk in cardiovascular disease associated with long-term corticosteroid use, the bottom line remains that people with lupus are living longer and better with current treatments, Dr. Schur says.