Skip to main content

Advertisement

SpringerLink
Log in

Burden of comorbidities in South Africans with systemic lupus erythematosus

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Introduction

To investigate the prevalence and spectrum of comorbidities in South Africans with systemic lupus erythematosus (SLE).

Patients and methods

A nested case-control study of a known alive group (AG) and deceased group (DG) of 200 and 40 patients, respectively, matched for age and sex, attending a tertiary Lupus Clinic. Comorbidities that were documented included, but not restricted to, those listed in the Charlson comorbidity index (CCI). Lupus disease severity was assessed using the lupus severity index (LSI).

Results

Patients were mainly black female (94%), and the median age (IQR) and median disease duration (IQR) were 33 (25–42) and 6 (3–11) years, respectively. Overall, 191 (79.5%) patients experienced ≥ 1 comorbidities. The median (IQR) LSI and CCI scores were significantly higher in the DG than the AG (8.5 (6.7–9.1) vs 6.3 (5.2–8.3), p < 0.001 and 1 (1–3) vs 0 (0–2), p = 0.002, respectively). The commonest comorbidities were hypertension (42%), serious infections (36.6%) and tuberculosis (TB) (18.8%), the latter two being significantly more common in the DG (OR = 7.34, p < 0.0001 and OR = 3.40, p = 0.001, respectively). Of the CCI comorbidities, congestive cardiac failure (OR = 10.39, p = 0.0003), cerebrovascular disease (OR = 7.29, p = 0.01) and chronic kidney disease (OR = 3.08, p = 0.02) were more common in the DG. Both serious infections and TB were independent predictors of death.

Conclusion

In this study of predominantly black South African SLE patients, comorbidities were common, with serious infections and TB amongst the commonest comorbidities. Unlike in industrialised Caucasian populations, cardiovascular comorbidities were rare in spite of a high prevalence of HPT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tikly M, Navarra SV (2008) Lupus in the developing world--is it any different? Best Pract Res Clin Rheumatol 22(4):643–655

  2. Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W (2017) The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology 56(11):1945–1961

    Article  PubMed  Google Scholar 

  3. Urowitz MB, Bookman AA, Koehler BE, Gordon DA, Smythe HA, Ogryzlo MA (1976) The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 60(2):221–225

    Article  CAS  PubMed  Google Scholar 

  4. Wadee S, Tikly M, Hopley M (2007) Causes and predictors of death in South Africans with systemic lupus erythematosus. Rheumatology 46(9):1487–1491

    Article  CAS  PubMed  Google Scholar 

  5. Dubula T, Mody GM (2015) Spectrum of infections and outcome among hospitalized South Africans with systemic lupus erythematosus. Clin Rheumatol 34(3):479–488

    Article  PubMed  Google Scholar 

  6. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Aydintug AO, Jedryka-Goral A, de Ramon E, Fernandez-Nebro A, Galeazzi M, Haga HJ, Mathieu A, Houssiau F, Ruiz-Irastorza G, Ingelmo M, Hughes GR (1999) Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European working party on systemic lupus erythematosus. Medicine 78(3):167–175

    Article  CAS  PubMed  Google Scholar 

  7. Kang SC, Hwang SJ, Chang YS, Chou CT, Tsai CY (2012) Characteristics of comorbidities and costs among patients who died from systemic lupus erythematosus in Taiwan. Arch Med Sci : AMS 8 (4):690–696

  8. Goobie GC, Bernatsky S, Ramsey-Goldman R, Clarke AE (2015) Malignancies in systemic lupus erythematosus: a 2015 update. Curr Opin Rheumatol 27(5):454–460

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Wolfe F, Michaud K, Li T, Katz RS (2010) Chronic conditions and health problems in rheumatic diseases: comparisons with rheumatoid arthritis, noninflammatory rheumatic disorders, systemic lupus erythematosus, and fibromyalgia. J Rheumatol 37(2):305–315

    Article  PubMed  Google Scholar 

  10. Rua-Figueroa I, Lopez-Longo J, Galindo-Izquierdo M, Calvo-Alen J, Del Campo V, Olive-Marques A, Perez-Vicente S, Fernandez-Nebro A, Andres M, Erausquin C, Tomero E, Horcada L, Uriarte E, Freire M, Montilla C, Sanchez-Atrio A, Santos G, Boteanu A, Diez-Alvarez E, Narvaez J, Martinez-Taboada V, Silva-Fernandez L, Ruiz-Lucea E, Andreu JL, Hernandez-Beriain JA, Gantes M, Hernandez-Cruz B, Perez-Venegas J, Pecondon-Espanol A, Marras C, Ibanez-Barcelo M, Bonilla G, Torrente V, Castellvi I, Alegre JJ, Calvet J, Marenco JL, Raya E, Vazquez T, Quevedo V, Munoz-Fernandez S, Rodriguez-Gomez M, Ibanez J, Pego-Reigosa JM (2017) Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus. Semin Arthritis Rheum 47(1):38–45

    Article  PubMed  Google Scholar 

  11. Barnado A, Carroll RJ, Casey C, Wheless L, Denny JC, Crofford LJ (2018) Phenome-wide association study identifies marked increased in burden of comorbidities in African Americans with systemic lupus erythematosus. Arthritis Res Therapy 20(1):69

    Article  Google Scholar 

  12. Barbhaiya M, Feldman CH, Guan H, Gomez-Puerta JA, Fischer MA, Solomon DH, Everett B, Costenbader KH (2017) Race/ethnicity and cardiovascular events among patients with systemic lupus erythematosus. Arthritis Rheum (Hoboken, NJ) 69(9):1823–1831

    Article  Google Scholar 

  13. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725

    Article  CAS  PubMed  Google Scholar 

  14. Jonsen A, Clarke AE, Joseph L, Belisle P, Bernatsky S, Nived O, Bengtsson AA, Sturfelt G, Pineau CA (2011) Association of the Charlson comorbidity index with mortality in systemic lupus erythematosus. Arthritis Care Res 63(9):1233–1237

    Article  CAS  Google Scholar 

  15. Bello GA, Brown MA, Kelly JA, Thanou A, James JA, Montgomery CG (2016) Development and validation of a simple lupus severity index using ACR criteria for classification of SLE. Lupus Sci Med 3(1):e000136

    Article  PubMed  PubMed Central  Google Scholar 

  16. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 15(2):241–250

    Article  PubMed  Google Scholar 

  17. Hodkinson B, Musenge E, Tikly M (2009) Osteoarticular tuberculosis in patients with systemic lupus erythematosus. QJM : Monthly J Assoc Phys 102(5):321–328

    Article  CAS  Google Scholar 

  18. World Health Organisiation (2017) Global Health Education information about tuberculosis. Switzerland, Geneva Accessed 12 January 2017

    Google Scholar 

  19. Oloo SA (2016) Implications of the 2015 World Health Organization isoniazid preventive therapy recommendations on tuberculosis prevention efforts in Namibia. South Afr Med J = Suid-Afrikaanse tydskrif vir geneeskunde 106(8):775–776

    Google Scholar 

  20. Falagas ME, Voidonikola PT, Angelousi AG (2007) Tuberculosis in patients with systemic rheumatic or pulmonary diseases treated with glucocorticosteroids and the preventive role of isoniazid: a review of the available evidence. Int J Antimicrob Agents 30(6):477–486

    Article  CAS  PubMed  Google Scholar 

  21. Mok MY, Lo Y, Chan TM, Wong WS, Lau CS (2005) Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy. J Rheumatol 32(4):609–615

    CAS  PubMed  Google Scholar 

  22. Gaitonde S, Pathan E, Sule A, Mittal G, Joshi VR (2002) Efficacy of isoniazid prophylaxis in patients with systemic lupus erythematosus receiving long term steroid treatment. Ann Rheum Dis 61(3):251–253

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Bruce IN, O'Keeffe AG, Farewell V, Hanly JG, Manzi S, Su L, Gladman DD, Bae SC, Sanchez-Guerrero J, Romero-Diaz J, Gordon C, Wallace DJ, Clarke AE, Bernatsky S, Ginzler EM, Isenberg DA, Rahman A, Merrill JT, Alarcon GS, Fessler BJ, Fortin PR, Petri M, Steinsson K, Dooley MA, Khamashta MA, Ramsey-Goldman R, Zoma AA, Sturfelt GK, Nived O, Aranow C, Mackay M, Ramos-Casals M, van Vollenhoven RF, Kalunian KC, Ruiz-Irastorza G, Lim S, Kamen DL, Peschken CA, Inanc M, Urowitz MB (2015) Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the systemic lupus international collaborating clinics (SLICC) inception cohort. Ann Rheum Dis 74(9):1706–1713

    Article  CAS  PubMed  Google Scholar 

  24. Sliwa K, Wilkinson D, Hansen C, Ntyintyane L, Tibazarwa K, Becker A, Stewart S (2008) Spectrum of heart disease and risk factors in a black urban population in South Africa (the heart of Soweto study): a cohort study. Lancet (London, England) 371(9616):915–922

    Article  Google Scholar 

  25. Thorburn CM, Ward MM (2003) Hospitalizations for coronary artery disease among patients with systemic lupus erythematosus. Arthritis Rheum 48(9):2519–2523

    Article  PubMed  Google Scholar 

  26. Tallbacka KR, Pettersson T, Pukkala E (2018) Increased incidence of cancer in systemic lupus erythematosus: a Finnish cohort study with more than 25 years of follow-up. Scand J Rheumatol:1–4

  27. Ognenovski VM, Marder W, Somers EC, Johnston CM, Farrehi JG, Selvaggi SM, McCune WJ (2004) Increased incidence of cervical intraepithelial neoplasia in women with systemic lupus erythematosus treated with intravenous cyclophosphamide. J Rheumatol 31(9):1763–1767

    CAS  PubMed  Google Scholar 

  28. Oeser A, Chung CP, Asanuma Y, Avalos I, Stein CM (2005) Obesity is an independent contributor to functional capacity and inflammation in systemic lupus erythematosus. Arthritis Rheum 52(11):3651–3659

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work has been supported by the Connective Tissue Diseases Research Fund, University of the Witwatersrand, and Medical Research Council of South Africa.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

    L. Greenstein

  2. Division of Rheumatology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, P.O. Bertsham, Johannesburg, 2013, South Africa

    K. Makan & Mohammed Tikly

Authors
  1. L. Greenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Makan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammed Tikly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammed Tikly.

Ethics declarations

Ethical standards

The study was approved by the Human Research Ethics Committee of the University of the Witwatersrand (clearance certificate number M1409790), and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Disclosure

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greenstein, L., Makan, K. & Tikly, M. Burden of comorbidities in South Africans with systemic lupus erythematosus. Clin Rheumatol 38, 2077–2082 (2019). https://doi.org/10.1007/s10067-019-04511-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-019-04511-7

Keywords

Search

Navigation