Purpose To examine the prevalence of comorbidities in SLE patients at the community as well as their impact on disease outcomes.1
Methods We utilised data from the Cretan Lupus Registry.2 Comorbidities were defined based on self-reported condition(s) and/or use of relevant treatments, and were accessed through face interviews upon enrollment (period 2012–2015). Data on organ damage (SLICC/ACR Damage Index [SDI]), disease severity (modified BILAG index) and hospitalizations were abstracted from the medical charts.
Results We included 399 SLE patients with mean age at diagnosis 43 years and disease duration 7 years. The total number of comorbidities was (mean ±SD) 3.4±2.4 and 42% of patients had multi-morbidity (>3 comorbidities). The mean Charlson Comorbidity Index was 0.9±1.1. The prevalence of major comorbidities in SLE patients and their co-occurrence matrix are shown in Figure 1 and Table 1, respectively. Most frequent physical comorbidity was thyroid disease (45%), which frequently (19%) concurred with a mental disorder. Although 36% of patients reported mental disorders, only 14% were regularly seen by a mental health professional. Female SLE patients had increased frequency of thyroid (51% versus 16%, p<0.001), allergic diseases (21% versus 3%, p=0.006), and osteoporosis (19% versus 6%, p=0.05) compared to male patients, whereas respiratory comorbidities (21% versus 9%, p<0.001) and alcohol abuse (3% versus 0%, p<0.01) were more prevalent among male patients. Analysis according to the place of residence revealed increased prevalence of respiratory comorbidities among patients who reside in rural (12.3%) versus urban (7.2%) or semi-urban (7.7%) regions (p=0.014). SLE patients with multi-morbidity had more hospitalizations due to active disease (2.2±5.8 versus 1.1±2.3, p<0.001) and increased organ damage accrual (SDI>0) (40.8% versus 28.5%, p=0.044) compared to those with ≤3 comorbidities. In multivariable analysis, age-adjusted Charlson Comorbidity Index was associated with disease severity (Odds Ratio 1.43, p<0.003)
Conclusions Our results from a community-based registry highlight a considerable burden of physical and mental multi-morbidity in SLE patients, which may be linked to adverse disease outcomes.
. Expert Rev Clin Immunol2017;13(8):753–768.
. Gergianaki I, et al. Ann Rheum Dis2017.
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