Multimorbidity in systemic lupus erythematosus in a population-based cohort: the lupus Midwest network

• Published in: Rheumatology (Oxford, England) Vol. 63; no. 11; pp. 3056 - 3064
• Main Authors: Figueroa-Parra, Gabriel, Meade-Aguilar, Jose A, Hulshizer, Cassondra A, Gunderson, Tina M, Chamberlain, Alanna M, Thanarajasingam, Uma, Greenlund, Kurt J, Barbour, Kamil E, Crowson, Cynthia S, Duarte-García, Alí
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-11-2024
• Subjects: Clinical Science; multimorbidity; damage; epidemiology; systemic lupus erythematosus; comorbidity; chronic disease
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/kead617

To assess the prevalence and incidence of multimorbidity and the association with the SLICC/ACR damage index (SDI) among patients with systemic lupus erythematosus (SLE).
Using prevalent and incident population-based cohorts of patients with SLE and their matched comparators, we assessed 57 chronic conditions. Chronic conditions were categorized as SDI-related or SDI-unrelated. Multimorbidity was defined as the presence of 2+ chronic conditions. Multimorbidity at prevalence and incidence/index was compared between cohorts using logistic regression. Cox models were used to examine development of multimorbidity after SLE incidence.
The prevalent cohort included 449 patients with established SLE on January 1, 2015. They were three times more likely to have multimorbidity compared with non-SLE comparators (OR 2.98, 95% CI 2.18-4.11). The incident cohort included 270 patients with new-onset SLE. At SLE incidence, patients with SLE were more likely to have multimorbidity than comparators (OR 2.27, 95% CI 1.59-3.27). After incidence, the risk of developing multimorbidity was 2-fold higher among patients with SLE than comparators (hazard ratio (HR) 2.11, 95% CI 1.59-2.80). Development of multimorbidity was higher in patients with SLE based on SDI-related (HR 2.91, 95% CI 2.17-3.88) and SDI-unrelated conditions (HR 1.73, 95% CI, 1.32-2.26).
Patients with SLE have a higher burden of multimorbidity, even before the onset of the disease. The risk disparity continues after SLE classification and is also seen in a prevalent SLE cohort. Multimorbidity is driven both by SDI-related and unrelated conditions.