Education, employment, absenteeism, and work disability in women with systemic lupus erythematosus.

OBJECTIVES: To study education, employment, absenteeism, and work disability (WD) in women with systemic lupus erythematosus (SLE) compared to population controls. METHOD: The study included 181 women of working age with SLE (mean age 44.0 years, disease duration 12.7 years) and 549 female population controls matched for age living in the same metropolitan area of Helsinki. Data regarding education, employment, absenteeism, and WD in patients and controls were obtained by questionnaire and personal interview. RESULTS: Basic education, vocational, or academic degrees and occupational categories in patients with SLE were similar to those in controls. In total, 62% of the patients were employed, compared to 77% of the controls (p < 0.001). During the preceding 12 months, employed SLE patients had been on sick leave for 25.4 days vs. 10.2 days in controls (p < 0.001). Subjective work ability regarding physical and mental demands of the job were lower in SLE patients than in controls (p < 0.001 and p = 0.036, respectively). The rate of permanent WD, defined as receiving disability benefits, was 34.3% in SLE patients vs. 10.3% in controls (p < 0.001). Cumulative WD due to SLE 5, 10, and 20 years after the clinical diagnosis was 13, 22, and 47%, respectively. CONCLUSIONS: SLE does not seem to affect educational achievements and the employment rate for SLE patients is reasonably high. Absenteeism and work disability are, however, 2-3 times more common than in controls. Less than half of the patients were on permanent disability pension due to SLE 20 years after diagnosis of the disease.

Frequency of and risk factors for symptomatic bone fractures in patients with systemic lupus erythematosus.

OBJECTIVES: To study risk factors for symptomatic bone fractures in patients with systemic lupus erythematosus (SLE) and to compare the frequency of fractures between SLE patients and population controls. METHOD: The study included 222 SLE patients [mean age 47.0 years, disease duration 13.1 years, 204 (92%) women] and 720 population controls living in the metropolitan area of Helsinki. The history of symptomatic bone fractures in SLE patients and controls was recorded by interview, and demographic and clinical data of SLE patients were obtained by interview, clinical examination, and chart review. RESULTS: A history of at least one symptomatic bone fracture was recorded in 93 (42%) of all 222 patients with SLE. The risk of any fracture in 204 women with SLE compared to controls was 1.8 [95% confidence interval (CI) 1.3-2.4] and fractures in the ankle, hip, and vertebral column were more common than in female controls, with odds ratios (ORs) of 2.0 (95% CI 1.1-3.7), 5.1 (95% CI 1.2-21.5), and 4.0 (95% CI 1.8-8.6), respectively. In 18 men with SLE, compared to male controls, no difference in the frequency of fractures was observed (OR 0.7, 95% CI 0.3-2.0). Risk factors for bone fractures in women with SLE were age (p = 0.008), comorbidity (p = 0.050), and the duration of corticosteroid use (p = 0.025). CONCLUSIONS: Symptomatic bone fractures, especially in the ankle, hip, and vertebral column, are common in women with SLE. Special attention should be paid to preventing fractures in elderly female patients with comorbidities and a long duration of corticosteroid use.

Reproductive health in women with systemic lupus erythematosus compared to population controls.

OBJECTIVE: To study the reproductive health history in women with systemic lupus erythematosus (SLE) compared to population controls. METHODS: A total of 206 female SLE patients were interviewed regarding demographic and disease data, menstruation, use of contraception and hormone replacement therapy (HRT), infertility, and pregnancies. The control group consisted of 1037 women from the general population of similar age and socioeconomic status living in the same region. RESULTS: In SLE women compared to population controls, mean age at menarche (13.3 vs. 13.2 years) and frequency of infertility (16% vs. 16%) were similar but menopause occurred earlier (44.9 vs. 46.8 years, p = 0.01). Current use of oral contraceptives (OCs) was less common than in controls [18% vs. 28%, odds ratio (OR) 0.55, 95% CI 0.3-1.0] while previous use of progesterone-containing intrauterine devices (IUDs) was more common (13% vs. 5%, OR 3.2, 95% CI 1.9-5.4). Current use of HRT was similar (22% vs. 21%) but SLE patients had started the use earlier (43.2 vs. 47.1 years, p = 0.003). Mean number of pregnancies was lower in SLE patients compared to controls (2.3 vs. 2.5, p = 0.046) and in lupus nephritis patients compared to SLE patients without nephritis (1.9 vs. 2.5, p = 0.01). No difference was found in the occurrence of spontaneous and induced abortions compared to controls, but pregnancy-associated complications were more common in SLE women. CONCLUSION: When compared to population controls women with SLE are normally fertile, use less OCs and more IUDs, have earlier menopause and use HRT as frequently. Family size is reduced, especially in lupus nephritis patients, and pregnancy-associated complications are more common.