High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete

Abstract

Comorbidities and multimorbidity, often complicating the disease course of patients with chronic inflammatory rheumatic diseases, may be influenced by disease-intrinsic and extrinsic determinants including regional and social factors. We analyzed the frequency and co-segregation of self-reported comorbid diseases in a community-based Mediterranean registry of patients (n = 399) with systemic lupus erythematosus (SLE). Predictors for multimorbidity were identified by multivariable logistic regression, strongly-associated pairs of comorbidities by the Cramer’s V-statistic, and comorbidities clusters by hierarchical agglomerative clustering. Among the most prevalent comorbidities were thyroid (45.6%) and metabolic disorders (hypertension: 24.6%, dyslipidemia: 33.3%, obesity: 35.3%), followed by osteoporosis (22.3%), cardiovascular (20.8%), and allergic (20.6%) disorders. Mental comorbidities were also common, particularly depression (26.7%) and generalized anxiety disorder (10.7%). Notably, 51.0% of patients had ≥3 physical and 33.1% had ≥2 mental comorbidities, with a large fraction (n = 86) displaying multimorbidity from both domains. Sociodemographic (education level, marital status) and clinical (disease severity, neurological involvement) were independently associated with physical or mental comorbidity. Patients were grouped into five distinct clusters of variably prevalent comorbid diseases from different organs and domains, which correlated with SLE severity patterns. Conclusively, our results suggest a high multimorbidity burden in patients with SLE at the community, advocating for integrated care to optimize outcomes.

High risk of depression, anxiety, and an unfavorable complex comorbidity profile is associated with SLE: a nationwide patient-level study

“…The prevalence of comorbid depression and anxiety in patients with SLE in the administrative claims data analyzed in our study was 9.9% and 12.7%, respectively, which is lower than the self-reported or healthcare professional-reported prevalence found by a recent systematic review and meta-analysis (depression - 35.0% [95% CI 29.9–40.3%]) and anxiety - 25.8% [95% CI 19.2–32.9%]) [ 17 ]. Our results are comparable with a full population study conducted in Crete that reported the prevalence of depression and anxiety to be 26.7% and 10.7%, respectively [ 34 ].…”

“…A recent Finnish study analyzed data of patients with SLE and matched controls from 2000 to 2015 and reported comorbid cardiovascular diseases (33%), malignancies (27%), and neurological diseases (10%) present at diagnosis to be the leading causes of death [ 35 ]. A full population study in Crete also reported a high prevalence of comorbid thyroid disease (45.6%), mental disorders (42.1%), dyslipidemia (33.3%), and hypertension (24.6%) [ 34 ].…”

Comorbidity in young patients with juvenile systemic lupus erythematosus: how can we improve management?

“…We know that adults with SLE are five times more likely to suffer from comorbidity compared to the age-matched general population [20], due to a combination of factors, such as disease activity, medication, and socioeconomic factors. The burden of comorbidity is significant in adults with SLE, with one study reporting that more than 50% of SLE patients reported three or more physical comorbidities [21].…”

“…Subclinical atherosclerosis can be associated with both traditional and non-traditional CVR factors in this patient population [29], suggesting an increased risk for CVD comorbidity from early age. More than one in three patients aged 10-21 years recruited to the Atherosclerosis Prevention in Paediatric Lupus Erythematosus (APPLE) study (investigating treatment with atorvastatin for atherosclerosis prevention in JSLE) had hypertension [30], while a recent large cohort study of adults with SLE estimated its prevalence at 24.6% [21]. Dyslipidaemia was also found to be more common in JSLE than in adult-onset SLE [21,31], while the prevalence of obesity was comparable [21,32].…”

“…More than one in three patients aged 10-21 years recruited to the Atherosclerosis Prevention in Paediatric Lupus Erythematosus (APPLE) study (investigating treatment with atorvastatin for atherosclerosis prevention in JSLE) had hypertension [30], while a recent large cohort study of adults with SLE estimated its prevalence at 24.6% [21]. Dyslipidaemia was also found to be more common in JSLE than in adult-onset SLE [21,31], while the prevalence of obesity was comparable [21,32]. One in 5 children with JSLE had osteoporosis [33], which is more than reported in adults with SLE in a recent meta-analysis [34].…”