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Systemic Lupus Erythematosus

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Comorbidity in Rheumatic Diseases

Abstract

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease associated with greater comorbidity in comparison to the general population. Individuals with SLE are at increased risk of developing cardiovascular disease, stroke, cancer, osteoporosis, and infection among others. Some others, such as vitamin D deficiency in SLE, may have a dual role in disease activity and bone health. End-stage renal disease, infection, and cardiovascular disease remain the leading causes of death. Risk of cardiovascular disease continues to be poorly addressed in SLE, with an increased rate of hospitalization for acute myocardial infarction and ischemic stroke, in contrast to decreasing rate of hospitalization in the general population. Other increased risks for cardiovascular complications include hypertension, premature coronary artery disease, and cerebrovascular events. It can be difficult to distinguish between the contribution of disease activity and its duration and the enhancing effect of chronic glucocorticoid use. Infections commonly complicate the course of SLE with a higher risk of major infections in patients with steroids, even at moderate doses. A wide spectrum of infections has been reported in SLE, mostly bacterial, but opportunistic infections may occur. In addition, SLE is associated with an overall increase incidence of malignancy, mainly non-Hodgkin lymphoma, Hodgkin’s lymphoma, leukemia, and laryngeal, lung, liver, vagina/vulvar, and thyroid malignancies. A decreased risk in other malignancies especially cancers of the breast, endometrium, and prostate have been reported. Fibromyalgia may complicate the course of the disease. Physicians need to be alert in recognizing the onset when depression and widespread pain coexist. The burden of comorbidity is associated not only with higher mortality but also with poorer quality of life and increased utilization of hospital and medical resources. Clinicians should be aware of the increased risks and consider treatment of comorbidities as an integral part of the clinical care of these patients.

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Authors and Affiliations

  1. Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA

    Isabel Castrejon MD, PhD, Ailda Nika MD, Winston Sequeira MD & Meenakshi Jolly MD, MS

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  1. Isabel Castrejon MD, PhD
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  2. Ailda Nika MD
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Correspondence to Isabel Castrejon MD, PhD .

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  1. Consultant Rheumatologist, Department of Rheumatology, Darent Valley Hospital, Dartford, Kent, United Kingdom

    Yasser El Miedany

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Castrejon, I., Nika, A., Sequeira, W., Jolly, M. (2017). Systemic Lupus Erythematosus. In: El Miedany, Y. (eds) Comorbidity in Rheumatic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-59963-2_6

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  • DOI: https://doi.org/10.1007/978-3-319-59963-2_6

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