Abstract
Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease. It has protean clinical manifestations making it difficult to diagnose. This thesis is an investigation of the utility of the General Practice Research Database (GPRD) for the study of SLE epidemiology and management. Methods: A number of studies have been conducted to describe the epidemiology of SLE in the UK between 1992 and 1998 as well as a case-control study of its presentation and a descriptive analysis of its management. Results: Cases of SLE can be identified from the GPRD population based on a diagnosis of SLE with evidence of treatment in hospital and/or long term therapy consistent with SLE. Incidence was 3.8/100,000/year and highest in women aged 30-69 years, challenging the traditional description of SLE as a disease of "women of childbearing age". Prevalence increased from 1992 to 1998 which was an artefact resulting from the relapsing-remitting nature of this disease. The SMR for SLE was 1.83. Women aged 20-29 had a 17-fold risk of death compared with the general population. SLE patients had more musculoskeletal and cutaneous symptoms than individuals in the general population for five years before diagnosis. A model has been developed that might be useful for the earlier recognition of SLE. Management of SLE was consistent with previous studies other than the use of combined oral contraceptives, which did not change following diagnosis as would be expected from the prescribing guidelines. Conclusions: The GPRD is more reliable for the identification of incident than prevalent cases of SLE. SLE remains a disease that is difficult to diagnose in primary care; general practitioners should be made more aware of the insidious onset of SLE and its frequency in women of peri- and postmenopausal age.