{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:29Z","timestamp":1792787309782,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"unspecified","delay-in-days":84,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Pancretan Health Association"},{"name":"Special Account for Research Funds of the University of Crete","id":[{"id":"https:\/\/ror.org\/00dr28g20","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,8,24]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with systemic lupus erythematosus (SLE) carry a substantial comorbidity load associated with worse prognosis, yet most evidence pertains to long-standing disease. How comorbidities\u2014particularly multimorbidity as a marker of overall health burden\u2014evolve at early stages, and whether conditions co-aggregate into clinically meaningful clusters, remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An inception cohort (\u22642 years from diagnosis) of 311 patients with SLE with 5-year monitoring of 140 comorbidities, disease activity, treatments, organ damage and adverse events\/hospitalisations. Growth mixture modelling identified trajectories of incident comorbidities, while tetrachoric exploratory factor analysis followed by clustering defined multimorbidity profiles; these trajectories and profiles were then related to longitudinal outcomes. To inform temporal ordering, trajectory modelling was refitted for months 24\u201360,\u2009and predictors from &lt;24\u2009months were evaluated using penalised multivariable regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Early SLE separated into slow (55%) and fast (45%) incident-comorbidity trajectories. Among fast accruers, three phenotypes emerged: low-to-moderate (general\/non-patterned) (51%), metabolic-psychiatric (31%) and cardiopulmonary-musculoskeletal (18%), with a gradual increase in multimorbidity (\u22652 conditions) (32.7%, 65.7% and 100%, respectively). Compared with slow-accruing, fast-accruing patients\u2014especially the metabolic-psychiatric and cardiopulmonary-musculoskeletal\u2014attained less lupus low disease activity state\/Definition of Remission In SLE and developed more damage (incidence rate ratio (IRR) 2.28\u20133.27) and safety-related events (IRR 1.89\u20133.36). Severe flares (\u226520% of time; OR 2.10, 95% CI 1.09 to 4.04) and glucocorticoid exposure (OR 1.06 per 10 mg\/day, 95% CI 1.01 to 1.11) during the first 24 months independently predicted subsequent fast-comorbidity trajectory. Flares were more prominent in the fast\/low-to-moderate and metabolic-psychiatric phenotypes, whereas glucocorticoid use was more prominent in the cardiopulmonary-musculoskeletal phenotype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly half of patients with newly diagnosed SLE show accelerated comorbidity and multimorbidity burden, underscoring the need for clinical vigilance. Fast-accrual phenotypes are linked to flares and glucocorticoid exposure, two potentially modifiable features of early disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2026-007076","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:10:46Z","timestamp":1790179846000},"page":"e007076","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Early SLE may follow a fast comorbidity\/multimorbidity trajectory associated with flare burden and glucocorticoid exposure"],"prefix":"10.1136","volume":"12","author":[{"given":"Myrto","family":"Nikoloudaki","sequence":"first","affiliation":[{"name":"Rheumatology and Clinical Immunology, University of Crete School of Medicine, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Pitsigavdaki","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology, University of Crete School of Medicine, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8575-5183","authenticated-orcid":false,"given":"Spyridon","family":"Katechis","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7654-8222","authenticated-orcid":false,"given":"Ettore","family":"Silvagni","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. 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