Patients with systemic lupus erythematosus (SLE) may encounter a variety of long-term health problems as they undergo treatment: bone disease, cardiovascular disease, cancer and infection are all risks that clinicians cannot ignore, Dr. Susan Manzi of the University of Pittsburgh’s Lupus Center of Excellence noted at the Congress of Clinical Rheumatology (CCR). Bone health: Women with SLE are known to be at higher risk for fractures. For example, a retrospective cohort study in 1999 showed that the incidence of nontraumatic fractures observed in more than 700 female SLE patients was more than 5 times that of the general population (Arthritis Rheum. 1999;42:882-90) Among female SLE patients of different ages, the standardized incidence ranged from 2.4 to 12.1, with the highest risk in patients aged 18 to 24 years, followed by patients aged 45 to 64 years, and again in ≥70 years old patients. ”We know that a significant portion of the patient’s bone loss is related to the treatment we (administered); we know that bone loss may be part of the underlying disease. Regardless, bone loss is real, and we need to monitor and intervene.” Dr. Manzi noted that the American College of Rheumatology (ACR) guidelines can provide help in reducing fractures in patients with connective tissue diseases, including lupus (Arthritis Care Res. 2010;62:1515-26). ・Cardiovascular health: Similar to bone health, the 1997 Framingham Offspring Study showed that patients with SLE had a significantly higher risk of myocardial infarction than the general population. In this study, Dr. Manzi and colleagues found that SLE patients in every age group had a higher incidence of myocardial infarction than their same-age controls. The risk of myocardial infarction in SLE patients aged 35 to 44 years was even higher than 50 times that of the overall study population (Am. J. Epidemiol. 1997;145:408-15). Notably, in 2011, the American Heart Association (AHA) identified women with lupus and rheumatoid arthritis (RA) as being at high risk for cardiovascular disease and made treatment and management recommendations for these women.The AHA concluded that SLE and RA may be unrecognized risk factors and that women with both diseases – even in the absence of clinically relevant cardiovascular disease – are at increased risk for myocardial infarction. -The AHA recommends that “virtually any female patient who has a cardiovascular event, especially if the cause of the event is unclear and the patient is young, should be Screening for lupus and RA”. Cancer: A 2005 study of more than 13,000 patients from 30 centers showed that lupus patients had a 20% higher risk of cancer than the general population. More recent data are similar, suggesting a 15-20% elevated risk (J. Autoimmun. 2013;42:130-5). The most significant elevated cancer risk in SLE patients is for hematologic tumors, such as lymphoma and leukemia. Lung and thyroid cancer risks were also elevated, and SLE patients also had a trend toward an elevated risk of cervical and vulvar cancers, which may be associated with human papillomavirus (HPV) infection. “This means that we should do more cervical smears and pelvic exams in SLE patients.” Interestingly, female SLE patients appear to have a lower risk of breast, ovarian and endometrial cancer, likely as a result of their avoidance of hormone replacement therapy (Arthritis Rheum. 2005;52:1481-90). ・Infection: Patients with lupus are known to be at higher risk for infection, suggesting that live attenuated vaccines, including herpes simplex virus vaccine, BCG, oral typhoid vaccine, MMR, varicella vaccine, oral polio vaccine, intranasal influenza vaccine, yellow fever vaccine, and endemic typhus vaccine, should be administered more carefully to patients with lupus. These vaccines are not recommended for SLE patients who are receiving immunosuppressive or biologic therapy, have low immunoglobulin levels or have hypocomplementemia.