Gergianaki Irini, Garantziotis Panagiotis, Adamichou Christina, Saridakis Ioannis, Spyrou Georgios, Sidiropoulos Prodromos, Bertsias George
Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece.
Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece.
J Clin Med. 2021 Mar 2;10(5):998. doi: 10.3390/jcm10050998.
Comorbidities and multimorbidity, often complicating the disease course of patients with chronic inflammatory rheumatic diseases, may be influenced by disease-intrinsic and extrinsic determinants including regional and social factors. We analyzed the frequency and co-segregation of self-reported comorbid diseases in a community-based Mediterranean registry of patients ( = 399) with systemic lupus erythematosus (SLE). Predictors for multimorbidity were identified by multivariable logistic regression, strongly-associated pairs of comorbidities by the Cramer's V-statistic, and comorbidities clusters by hierarchical agglomerative clustering. Among the most prevalent comorbidities were thyroid (45.6%) and metabolic disorders (hypertension: 24.6%, dyslipidemia: 33.3%, obesity: 35.3%), followed by osteoporosis (22.3%), cardiovascular (20.8%), and allergic (20.6%) disorders. Mental comorbidities were also common, particularly depression (26.7%) and generalized anxiety disorder (10.7%). Notably, 51.0% of patients had ≥3 physical and 33.1% had ≥2 mental comorbidities, with a large fraction ( = 86) displaying multimorbidity from both domains. Sociodemographic (education level, marital status) and clinical (disease severity, neurological involvement) were independently associated with physical or mental comorbidity. Patients were grouped into five distinct clusters of variably prevalent comorbid diseases from different organs and domains, which correlated with SLE severity patterns. Conclusively, our results suggest a high multimorbidity burden in patients with SLE at the community, advocating for integrated care to optimize outcomes.
合并症和多重疾病常常使慢性炎症性风湿性疾病患者的病程复杂化，可能受到包括地区和社会因素在内的疾病内在和外在决定因素的影响。我们分析了地中海地区一个基于社区的系统性红斑狼疮（SLE）患者登记处（n = 399）自我报告的合并症的频率和共分离情况。通过多变量逻辑回归确定多重疾病的预测因素，通过克莱默V统计量确定合并症的强相关对，并通过层次聚类分析确定合并症集群。最常见的合并症包括甲状腺疾病（45.6%）和代谢紊乱（高血压：24.6%，血脂异常：33.3%，肥胖：35.3%），其次是骨质疏松症（22.3%）、心血管疾病（20.8%）和过敏性疾病（20.6%）。精神合并症也很常见，尤其是抑郁症（26.7%）和广泛性焦虑症（10.7%）。值得注意的是，51.0%的患者有≥3种躯体合并症，33.1%的患者有≥2种精神合并症，其中很大一部分（n = 86）在两个领域都表现为多重疾病。社会人口统计学（教育水平、婚姻状况）和临床（疾病严重程度、神经受累情况）与躯体或精神合并症独立相关。患者被分为五个不同的合并症集群，这些集群来自不同器官和领域，其患病率各不相同，且与SLE严重程度模式相关。总之，我们的结果表明社区中SLE患者的多重疾病负担很高，提倡进行综合护理以优化治疗效果。
