Association between disease duration and comorbidity burden in systemic lupus erythematosus: a multicentre study from
Arsalan Tariq1, Maarij Sharif2, Muhammad Ammar2
1University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan at81931@gmail.com.
Insights
Comorbidities like cardiovascular disease, chronic kidney disease, and osteoporosis are common in systemic lupus erythematosus (SLE) patients and increase with disease duration. Early, integrated management is crucial for improving outcomes in SLE patients.
Area of Science:
- Rheumatology and Immunology
- Cardiology
- Nephrology
- Endocrinology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with significant morbidity.
- Cardiovascular disease (CVD), chronic kidney disease (CKD), and osteoporosis are known complications of SLE.
- Understanding the prevalence and predictors of these comorbidities in specific populations is essential for targeted management.
Purpose of the Study:
- To determine the prevalence of CVD, CKD, and osteoporosis in SLE patients in Punjab, Pakistan.
- To identify predictors associated with the development of these comorbidities.
- To examine the relationship between disease duration and comorbidity burden in SLE.
Main Methods:
- A cross-sectional analysis of the prospective Punjab Lupus Registry (2020-2024) was performed.
- Data from 482 adult SLE patients meeting EULAR/ACR criteria were analyzed.
- Multivariable Poisson regression identified predictors of comorbidity burden, with disease activity assessed by SLEDAI-2K.
Main Results:
- 43.6% of SLE patients had at least one comorbidity; 15.1% had multimorbidity.
- Prevalence of CVD, CKD, and osteoporosis significantly increased with disease duration (p<0.001).
- Independent predictors included older age, longer disease duration, corticosteroid use, smoking, and low socioeconomic status; hydroxychloroquine was protective.
Conclusions:
- Comorbidities are highly prevalent in SLE patients and escalate with age and disease duration.
- These findings highlight the need for proactive screening and integrated management strategies.
- Early intervention and optimized treatment can potentially improve long-term outcomes for SLE patients.
Objective:
This study aimed to evaluate the prevalence and predictors of cardiovascular disease (CVD), chronic kidney disease (CKD) and osteoporosis among patients with systemic lupus erythematosus (SLE) in Punjab, Pakistan.
Methods:
A cross-sectional analysis of a prospective registry was conducted using data from the Punjab Lupus Registry between January 2020 and December 2024. Adults (≥18 years) fulfilling the 2019 European League Against Rheumatism/American College of Rheumatology SLE classification criteria were included. Of 536 registered patients, 482 with complete data were analysed. Comorbidities were physician-confirmed, and disease activity was assessed using Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Associations between disease duration and comorbidities were examined using χ² tests for trend, while predictors of comorbidity burden were identified using multivariable Poisson regression with robust error variance.
Results:
Among 482 patients (mean age 39.6±12.4 years; 67.2% female), 43.6% had at least one comorbidity and 15.1% had multimorbidity. The prevalence of CVD, CKD and osteoporosis increased with disease duration: 12.3%, 10.6% and 8.2% in <5 years versus 39.6%, 28.9% and 25.4% in >10 years (p<0.001). Older age (adjusted prevalence ratios (aPR) 1.31 per 10 years), longer disease duration (aPR 1.22 per 5 years), corticosteroid use (aPR 1.33), smoking (aPR 1.26) and low socioeconomic status (aPR 1.38) were independent predictors, while hydroxychloroquine use was protective (aPR 0.78). Patients with comorbidities had higher disease activity (SLEDAI-2K 6.9 vs 5.6, p=0.009) and greater organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index 2.4 vs 1.3, p<0.001).
Conclusion:
Comorbidities are common in SLE and increase with age and disease duration, underscoring the need for early, integrated management to improve outcomes.
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