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

Abstract

Objectives The aim of this national population-based, retrospective database study is to compare the comorbidity profiles of systemic lupus erythematosus (SLE) patients and general population controls matched for age, gender, and region and assess the risk of depression or anxiety when controlled for age, gender and adjusted for the Charlson Comorbidity Index (CCI). Methods Claims data of 1051 patients diagnosed with SLE (full population between January 01, 2011, and December 31, 2014) from the Hungarian National Health Insurance Fund have been analyzed against matched controls (1:5 ratio) with a follow-up of 30 months. The first record of SLE diagnosis was considered the diagnosis date. The odds ratio (OR) and 99.9% confidence interval (CI) of having depression or anxiety among patients with SLE vs. controls have been assessed using logistic regression models. Results SLE patients report more comorbidities than the matched general population both in pre- and post-index periods (mean CCI 1.79 vs. 1.15 and 2.78 vs. 1.22 [both p<0.001], respectively). Both SLE patients and controls diagnosed with depression or anxiety had significantly higher CCI than those without comorbid depression or anxiety (p<0.001). However, SLE patients had a twofold higher risk of depression or anxiety than matched controls when controlled for age, gender, and adjusted for CCI. Conclusion Our analysis indicates the enormity of comorbidity burden in SLE, especially that of anxiety and depression. The size and complexity of the comorbidity burden emphasizes the importance of early diagnosis and intervention with comprehensive modalities incorporating attention to comorbidities in SLE patients.

Recombinant adeno-associated virus 8 vector in gene therapy: Opportunities and challenges

“…SLE is prevalent in young women and often leads to multi-organ damage and flare-ups and remissions in SLE patients that can last for years or even decades. 51 , 52 Treatment of SLE primarily uses glucocorticoids and immunosuppressants; however, these drugs are known to cause many side effects. Researchers have tried to develop better treatment strategies based on findings from basic and clinical studies.…”

Posttraumatic stress disorder symptoms in systemic autoimmune rheumatic disease patients during the early COVID‐19 pandemic

“…Prior to the pandemic onset, people with SARD likely had a higher prevalence of stress-related disorders than those without SARD. [13][14][15][16][17][18] With the onset of the pandemic, patients with SARD taking immunosuppressants may have experienced more fear and anxiety than those in the general population due to the increased likelihood of severe illness tied to immunosuppression. 19,20 Reports from the initial COVID-19 outbreak in China and Italy suggested that patients with SARD experienced more severe PTSD symptoms early in the pandemic than did those without SARD.…”

“…How the COVID‐19 pandemic added to the multifaceted relationship between rheumatic disease and PTSD is not understood. Prior to the pandemic onset, people with SARD likely had a higher prevalence of stress‐related disorders than those without SARD 13–18 . With the onset of the pandemic, patients with SARD taking immunosuppressants may have experienced more fear and anxiety than those in the general population due to the increased likelihood of severe illness tied to immunosuppression 19,20 .…”

Clinical, psychosocial and demographic factors affect decisions in SLE people

“…Several mechanisms have been proposed as contributing factors to the development of NPSLE symptoms, including the presence of inflammatory cytokines and autoantibodies, blood-brain barrier disruption, and cerebrovascular alterations; it has also been suggested that NPSLE could be attributed to the damage generated by the disease and the application of different treatments (Kósa et al, 2022; Liu et al, 2022; Sarwar et al, 2021).…”

“…Pain, fatigue, cognitive dysfunction, major depression, and anxiety prevalence are estimated to be higher among people with SLE than in the general population. Depression and anxiety are considered among the most frequent and impactful neuropsychiatric manifestations of SLE; depression prevalence ranges between 2% and 91.7%, whereas anxiety is estimated to affect between 6.4% and 40% of the people with SLE (Kósa et al, 2022).…”