Evolution of Clinical Characteristics and Treatment Strategies in Turkish SLE Patients Over Two Decades: A Retrospective Cohort Study

Abstract Objective Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with diverse patterns of organ involvement, morbidity, and mortality. This study aimed to assess changes in demographic, clinical, and therapeutic characteristics of a single-center SLE cohort over the last two decades. Materials and methods This retrospective study included 409 SLE patients from the Rheumatology Department at Gazi University Faculty of Medicine, meeting the 2019 EULAR/ACR classification criteria. Patients were categorized by diagnosis year into two groups: 1987–2012 and 2013–2023. Results The proportion of male SLE patients increased approximately 2.5-fold in the last decade (5.2% vs. 12.6%, p = 0.008). While lupus nephritis rates remained stable, neurological (p = 0.012), hematological (p < 0.001), pulmonary (p < 0.001), and gastrointestinal (p < 0.001) involvements were significantly higher in the last decade. Use of mycophenolate mofetil (p = 0.036), methotrexate (p < 0.001), calcineurin inhibitors (p < 0.001), and rituximab (p < 0.001) increased, while steroid use (p = 0.044) and flare frequency (p = 0.035) decreased significantly. Although crude mortality rates improved (4.7% vs. 3.5%) without statistical significance (p = 0.54), male patients exhibited higher mortality rates than females (13.8% vs. 3.2%, p = 0.011). Hospitalization rates decreased but were not statistically significant (0.00130 vs. 0.00104/patient/year, p = 0.855). Conclusion Over the last two decades, SLE management has evolved with improved therapeutic approaches and changing clinical manifestations. However, mortality remains disproportionately higher in male patients, underscoring the need for targeted interventions.