A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfillment for the degree of Master of Medicine (Internal
Medicine)
February 2017 / Introduction:
Systemic lupus erythematosus (SLE) is a rare multisystem autoimmune disease
which occurs most severely in young females of African descent. Life expectancy is
reduced, either directly due to the disease itself or related comorbidities.
Aim of study:
To determine the prevalence and spectrum of comorbidities in patients with SLE
attending the Chris Hani Baragwanath Academic Hospital (CHBAH) Lupus Clinic.
Patients and Methods:
A retrospective record review of 200 SLE patients attending the CHBAH Lupus Clinic
for at least 6 months. Data collected included demographics, clinical and serological
evidence of SLE, autoantibody status, treatment modalities and comorbid conditions.
The Charlson Comorbidity Index was used to measure the total comorbidity burden.
Results:
The majority of patients were black females (94%) with a mean age (SD) of 34.6
years (11). Disease duration and American College of Rheumatology (ACR) criteria
fulfilled were 7 years and 5 respectively. The median (IQ range) CCI was 1 (0-3).
Baseline and cumulative prevalence of one or more comorbidities was 36.5% (95%
CI: 29.8-43.6%), and 56.0% (95% CI: 48.8-63.0%), respectively. The most frequent
comorbidities were hypertension (HPT) (43.5%), severe infections (29%),
tuberculosis (TB) (15%), and HIV infection (9%). Univariate risk factors for serious
infection were the number of ACR criteria fulfilled and leucopaenia, while both
univariate and multivariate risk factors were anti-Sm antibodies, thrombocytopaenia
and the use of immunosuppressive drugs. Risk factors for HPT included age at
onset, disease duration, CNS involvement and chloroquine use. Risk factors for TB
were disease duration and the use of azathioprine. Protective factors were age of
onset, arthritis as a clinical criteria and hypocomplementaemia.
Conclusion:
In this study of predominantly black females, comorbidities were common but the
spectrum differs to those reported in industrialised, Western countries. Infections,
both those requiring hospitalisation for intravenous antibiotics, and TB, were amongst
the commonest comorbidities, relating to risk factors such as the use of
immunosuppressive drugs, autoantibody status and disease duration. Furthermore,
despite the high prevalence of HPT, cardiovascular comorbidities were very rare. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/23170 |
| Date | January 2017 |
| Creators | Greenstein, Lara Sonia |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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