Co-morbidities in SLE (systemic lupus erythematosus)

Co-morbidities in SLE

Patients with SLE are at an increase risk of several co-morbidities when compared with the general population (1,2):

• can be either disease related morbidity or treatment related morbidity
• the following co-morbidities have been identified in lupus patients
  • cardiovascular diseases
    • e.g. - hypertension, dyslipidaemia
    • the risk is 5-6 times higher when compared to healthy controls
    • additionally lupus patients have a predisposition to premature atherosclerosis due to lupus-specific factors such as disease activity, renal disease and corticosteroid use.
  • osteoporosis
    • risk factors for reduced bone mineral density (BMD) include age, low body weight, inflammatory markers (ESR and CRP) and pre-existing organ damage
    • corticosteroid doses of >7.5 mg in particular are associated with a greater risk of osteoporosis
  • infection
    • remains the primary cause of mortality in approximately 25% patients with SLE
    • bacterial infections (specially pneumonia) are the most common reason for hospitalisation due to infection
    • most common
      • viral pathogen - herpes zoster
      • bacterial pathogen - S. pneumoniae, E. coli and S. aureus
    • both disease-related factors (lung involvement, renal disease, lymphopenia, complement consumption and functional hyposplenism) and drug-related effects (cumulative steroid exposure and immunosuppressant use) may increase the risk of infection
  • certain types of cancer (non-Hodgkin's lymphoma, lung cancer, hepatobiliary cancer)
  • thromboembolic disease

References:

1. Bertsias G, Ioannidis JP, Boletis J, et al. EULAR recommendations for the management of systemic lupus erythematosus. Report Ann Rheum Dis. 2008 Feb;67(2)
2. M Zen et al. Mortality and causes of death in systemic lupus erythematosus over the last decade: Data from a large population-based study. European Journal of Internal Medicine. Volume 112. p45-51 June 2023