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  • P132 Exploring the impact of comorbidity, multimorbidity, and mental health conditions on health related outcomes in systemic lupus erythematous: a global study

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P132 Exploring the impact of comorbidity, multimorbidity, and mental health conditions on health related outcomes in systemic lupus erythematous: a global study
  1. Gagandeep Sukhija1,
  2. Eman Elfar1,
  3. Amelia Holloway1,
  4. Sook Yan Lee1,
  5. Elena Nikiphorou1,2,
  6. Ioannis Parodis3,4,
  7. Naveen R5,
  8. Jessica Day6,7,8,
  9. Mrudula Joshi9,
  10. Sreoshy Saha10,
  11. Syahrul Sazliyana Shaharir11,
  12. Wanruchada Katchamart12,
  13. Phonpen Akawatcharangura Goo13,
  14. Lisa S Traboco14,
  15. Yi Ming Chen15,16,
  16. Parikshit Sen17,
  17. James B Lilleker18,19,
  18. Arvind Nune20,
  19. John D Pauling21,22,
  20. Ai Lyn Tan23,24,
  21. Nelly Ziade25,26,
  22. Marcin Milchert27,
  23. Abraham Edgar Gracia-Ramos28,
  24. Carlo Vinicio Caballero-Uribe29,
  25. COVAD Study Group Vikas Agarwal30,
  26. Rohit Aggarwal31,
  27. Latika Gupta32,33 and
  28. Chris Wincup1,2
  1. 1Rheumatology Dept., King’s College Hospital, London, UK
  2. 2Centre for Rheumatic Diseases, King’s College London, London, UK
  3. 3Division of Rheumatology, Dept. of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
  4. 4Dept. of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  5. 5Dept. of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  6. 6Dept. of Rheumatology, Royal Melbourne Hospital, Parkville, Australia
  7. 7Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
  8. 8Dept. of Medical Biology, University of Melbourne, Parkville, Australia
  9. 9Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
  10. 10Mymensingh Medical College, Mymensingh, Bangladesh
  11. 11Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur
  12. 12Division of Rheumatology, Dept. of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  13. 13Dept. of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
  14. 14Dept. of Medicine, Section of Rheumatology, St. Luke’s Medical Center-Global City, Taguig, Philippines
  15. 15Division of Allergy, Immunology and Rheumatology, Dept. of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
  16. 16Dept. of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
  17. 17Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, India
  18. 18Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
  19. 19Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
  20. 20Southport and Ormskirk Hospital NHS Trust, Southport, UK
  21. 21Bristol Medical School Translational Health Sciences, University of Bristol, UK
  22. 22Dept. of Rheumatology, North Bristol NHS Trust, Bristol, UK
  23. 23NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
  24. 24Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  25. 25Rheumatology Dept., Saint-Joseph University, Beirut, Lebanon
  26. 26Rheumatology Dept., Hotel-Dieu de France Hospital, Beirut, Lebanon
  27. 27Dept. of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
  28. 28Dept. of Internal Medicine, General Hospital, National Medical Center ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
  29. 29Dept. of Medicine, Hospital Universidad del Norte, Barranquilla, Atlantico, Colombia
  30. 30Dept. of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
  31. 31Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  32. 32Dept. of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  33. 33City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK

Abstract

Objective This study aimed to investigate the prevalence of comorbidity, multimorbidity and mental health disorders in patients with systemic lupus erythematous (SLE) and the association with patient reported physical and mental outcome scores (PROMIS).

Methods Data from the COVAD survey was utilised for analysis. Comorbidities including cardiovascular disease (ischaemic heart disease, hypertension, hypercholesterolaemia), diabetes, respiratory disease (interstitial lung disease, chronic obstructive pulmonary disease), chronic liver and renal failure were included. Comorbidity was categorised into 1. No comorbidities (nil); 2. Single comorbidity (SM); 3. Basic multimorbidity (BM, defined as two or more comorbidities); and 4. Complex multimorbidity (CM, defined as three or more chronic conditions affecting three different organ systems).1 The occurrence of mental health comorbidities (MHC) including anxiety and depression was evaluated separately. The association between prevalence of comorbidity and patient reported outcome score were analysed ANOVA, Chi square test and multivariate linear regression.

Results 1292 patients with SLE were included in this study. As shown in table 1, 41.56% of patients had at least one comorbidity (29.8% SM, 8.59%, BM, 3.17% CM). The complexity of comorbidity increased with age (p<0.0001) and disease duration (p<0.0001). The proportion of females was significantly higher in patients with no comorbidity (p<0.0001). Lower patient reported outcome scores for physical and mental health was higher with increasing complexity of comorbidity (p<0.0001) (figure 1). The decrease in physical function scores with comorbidity was still significant (p<0.0001) despite correcting for age or disease duration in multivariate analysis. Steroid use was more frequent with increasing multimorbidity (figure 1H). Hydroxychloroquine use was associated with lower complexity of comorbidity (p=0.0007).

Conclusions In this study, complex comorbidities were associated with lower patient reported outcomes scores relating to physical function and mental health. Increased steroid use (particularly at high dose) associated with CM, indicating either potential glucocorticoid related damage or more active disease. Female gender was protective and hydroxychloroquine use was associated with fewer comorbidities, supporting previous evidence. This study underscores the substantial need for insights into addressing comorbidities in SLE, and tailoring treatment for holistic patient management globally.

Reference

  1. Harrison C, Britt H, Miller G, et al. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open 2014;4:e004694.

View this table:
Abstract P132 Table 1

Demographic characteristics, patient reported outcome measures, medication use and multimorbidity

Abstract P132 Figure 1
Abstract P132 Figure 1

Differences in age (A), disease duration (B), fatigue levels (C) and pain (D) between comorbidity groups. No difference in physical health was observed between comorbidity groups (E). However, physical function was lower with increasing number of comorbidities (F). Mental health also decreased with higher numbers of comorbidities (G). Those with high complexity of comorbidity were more commonly on steroids, and more likely to be taking higher doses (H)

Declaration of interest ALT has received honoraria for advisory boards and speaking for Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB. EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly.

IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia Pharmaceuticals, Elli Lilly and Company, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis and F. Hoffmann-La Roche AG.JBL has received speaker honoraria/participated in advisory boards for Sanofi Genzyme, Roche, and Biogen. None is related to this manuscript. JD has received research funding from CSL Limited. NZ has received speaker fees, advisory board fees, and research grants from Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre; none are related to this manuscript. RA has a consultancy relationship with and/or has received research funding from the following companies: Bristol Myers-Squibb, Pfizer, Genentech, Octapharma, CSL Behring, Mallinckrodt, AstraZeneca, Corbus, Kezar, Abbvie, Janssen, Kyverna Alexion, Argenx, Q32, EMD-Serono, Boehringer Ingelheim, Roivant, Merck, Galapagos, Actigraph, Scipher, Horizon Therapeutics, Teva, Beigene, ANI Pharmaceuticals, Biogen, Nuvig, Capella Bioscience, and CabalettaBio. Rest of the authors have no conflict of interest relevant to this manuscript.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.186

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