Background Patients with systemic lupus erythematosus have a very high burden of comorbidities. Identification and management of these comorbidities are critical for optimal medical care to this population.
Objectives To assess the prevalence of comorbidities in SLE patients with pulmonary involvement.
Methods In a cross-sectional study, patients who fulfiled the SLICC (2012) classification criteria for SLE, were recruited from Rheumatology Departement. Data collection included demographics, disease duration, physician-rated indices of disease activity (by SLAM), damage (by SLICC/ACR DI) and Charlson comorbidity Index. The pulmonary involvement was assessed by chest X-ray, EcoCG Doppler and pulmonary functional tests.
Results The study included 106 patients (97 women, 9 males) with a mean age (±SD) of 41,1±12,6 yrs, mean disease duration of 90,3±87,3 months. The disease activity by SLAM was 11±5,17 points and mean SLICC/ACR DI 1,9±2,4 points (66% of patients had at least 1 point). Pulmonary assessment revealed that 45 (42,5%) patients had different types of pulmonary involvement due to lupus: pleuritis - 24 patients, pneumonitis – 1 patient, pulmonary embolism – 4 patients, interstitial lung disease – 15, shrinking lung syndrome – 1 and pulmonary arterial hypertension – 9 patients. The most frequent comorbidities in study group were: arterial hypertension - in 57 (53,7%) cases, from which 33 (57,9%) patients had pulmonary involvement and 24 (42,1%) without, obesity (BMI>30 kg/m2) had 29 (27,4%) patients, from which 17 (58,6%) with lung involvement and 12 (41,4%) without, anemia (Hb<110g/l) had 24 (22,6%) patients, from them 14 (58,3%) with lung disease and 10 (41,7%) patients - without, heart failure (I-II NYHA) had 23 (21,7%) patients, from them 20 (86,9%) were with lung implication, thyroiditis had 22 (20,8%) and 15 (68,2%) of them were with pulmonary involvement, diabetes mellitus type II had only 6 (5,7%) patients and half of them had lung disease. Assessing the impact of associated diseases through Charlson comorbidity index, we found that the score for patients diagnosed with damage to the respiratory system was twice as big vs. patients without respiratory impairment from SLE (6,3±2,4 vs. 3,4±1,4 points). Also, Charlson comorbidity score ≥1 was identified as a risk factor for lung involvement (OR 5,5294, 95% CI 2,367 – 12,91, p<0,01). Evaluation of disease activity by SLAM showed that patients with lung involvement have a higher disease activity vs. patients without (13,9±6,0 vs. 8,9±4,0, p<0,05).
Conclusions On the one hand, according to our results patients with SLE and pulmonary involvement have a higher prevalence of comorbidities comparative with patients without them. Hypertension was found to be the most common comorbidity and it was determined in 73,3% of patients with impaired respiratory system (p<0,01). On the other hand, association of comorbidities (Charlson comorbidity score ≥1) was identified as a risk factor for lung lesions.
Rees F., Doherty M., Grainge M. et al. The Burden of Comorbidity in Systemic Lupus Erythematosus. Rheumatology (2015), 54 (suppl_1): i166.
Disclosure of Interest None declared