{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:59:46Z","timestamp":1790225986992,"version":"4.1.0"},"reference-count":91,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T00:00:00Z","timestamp":1614643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Pancretan Health Organization","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Research Account of the University of Crete","award":["KA10210"],"award-info":[{"award-number":["KA10210"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 (n = 399) with systemic lupus erythematosus (SLE). Predictors for multimorbidity were identified by multivariable logistic regression, strongly-associated pairs of comorbidities by the Cramer\u2019s 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 \u22653 physical and 33.1% had \u22652 mental comorbidities, with a large fraction (n = 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.<\/jats:p>","DOI":"10.3390\/jcm10050998","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T04:42:46Z","timestamp":1614660166000},"page":"998","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete"],"prefix":"10.3390","volume":"10","author":[{"given":"Irini","family":"Gergianaki","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece"},{"name":"Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece"},{"name":"Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Garantziotis","sequence":"additional","affiliation":[{"name":"Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece"},{"name":"Division of Immunology and Rheumatology, Hannover Medical University, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7374-7795","authenticated-orcid":false,"given":"Christina","family":"Adamichou","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece"},{"name":"Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Saridakis","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece"},{"name":"Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Spyrou","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece"},{"name":"Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prodromos","family":"Sidiropoulos","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece"},{"name":"Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece"},{"name":"Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5299-1406","authenticated-orcid":false,"given":"George","family":"Bertsias","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Crete School of Medicine, 71500 Giofirakia, Greece"},{"name":"Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, 71500 Heraklion, Greece"},{"name":"Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/1744666X.2017.1327353","article-title":"The evolving concept of SLE comorbidities","volume":"13","author":"Gonzalez","year":"2017","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0002-9343(76)90431-9","article-title":"The bimodal mortality pattern of systemic lupus erythematosus","volume":"60","author":"Urowitz","year":"1976","journal-title":"Am. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1002\/acr.22751","article-title":"Burden of comorbidity in systemic lupus erythematosus in the UK, 1999\u20132012","volume":"68","author":"Rees","year":"2016","journal-title":"Arthritis Care Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.1093\/rheumatology\/keaa188","article-title":"Large-scale mortality gap between SLE and control population is associated with increased infection-related mortality in lupus","volume":"59","author":"Kedves","year":"2020","journal-title":"Rheumatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.semarthrit.2017.01.010","article-title":"Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus","volume":"47","author":"Andres","year":"2017","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1002\/acr.22575","article-title":"Burden of serious infections in adults with systemic lupus erythematosus: A national population-based study, 1996\u20132011","volume":"67","author":"Tektonidou","year":"2015","journal-title":"Arthritis Care Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1136\/annrheumdis-2012-202106","article-title":"Clinical associations of the metabolic syndrome in systemic lupus erythematosus: Data from an international inception cohort","volume":"72","author":"Parker","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.semarthrit.2015.10.010","article-title":"Dyslipidemia in systemic lupus erythematosus: Just another comorbidity?","volume":"45","author":"Tselios","year":"2016","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1016\/j.mayocp.2019.01.044","article-title":"Systemic lupus erythematosus and increased prevalence of atherosclerotic cardiovascular disease in hospitalized patients","volume":"94","author":"Katz","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1002\/acr.20122","article-title":"Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus","volume":"62","author":"Urowitz","year":"2010","journal-title":"Arthritis Care Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2121","DOI":"10.1097\/MD.0000000000002121","article-title":"Risk of peripheral arterial occlusive disease in patients with systemic lupus erythematosus: A nationwide population-based cohort study","volume":"94","author":"Chuang","year":"2015","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e000168","DOI":"10.1136\/rmdopen-2015-000168","article-title":"Stroke in systemic lupus erythematosus: A meta-analysis of population-based cohort studies","volume":"1","author":"Holmqvist","year":"2015","journal-title":"RMD Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.semarthrit.2012.12.002","article-title":"The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: A systematic review","volume":"43","author":"Schoenfeld","year":"2013","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Cao, L., Tong, H., Xu, G., Liu, P., Meng, H., Wang, J., Zhao, X., Tang, Y., and Jin, J. (2015). Systemic lupus erythematous and malignancy risk: A meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122964"},{"key":"ref_15","first-page":"613","article-title":"Cervical neoplasia in systemic lupus erythematosus: A nationwide study","volume":"56","author":"Wadstrom","year":"2017","journal-title":"Rheumatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"721","DOI":"10.4103\/0973-1482.172115","article-title":"Systemic lupus erythematous increased lung cancer risk: Evidence from a meta-analysis","volume":"12","author":"Wu","year":"2016","journal-title":"J. Cancer Res. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mendoza-Pinto, C., Rojas-Villarraga, A., Molano-Gonzalez, N., Jimenez-Herrera, E.A., Leon-Vazquez, M.L., Montiel-Jarquin, A., Garcia-Carrasco, M., and Cervera, R. (2018). Bone mineral density and vertebral fractures in patients with systemic lupus erythematosus: A systematic review and meta-regression. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0196113"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1002\/art.40818","article-title":"Comparative fracture risks among United States medicaid enrollees with and those without systemic lupus erythematosus","volume":"71","author":"Tedeschi","year":"2019","journal-title":"Arthritis Rheumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s00296-014-2972-8","article-title":"Fibromyalgia in patients with other rheumatic diseases: Prevalence and relationship with disease activity","volume":"34","author":"Haliloglu","year":"2014","journal-title":"Rheumatol. Int."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhang, L., Fu, T., Yin, R., Zhang, Q., and Shen, B. (2017). Prevalence of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1234-1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1038\/nrrheum.2013.212","article-title":"Multimorbidity and rheumatic conditions-enhancing the concept of comorbidity","volume":"10","author":"Radner","year":"2014","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.3899\/jrheum.101054","article-title":"Thrombovascular events affect quality of life in patients with systemic lupus erythematosus","volume":"38","author":"Balitsky","year":"2011","journal-title":"J. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/j.1756-185X.2011.01698.x","article-title":"The impact of obesity in systemic lupus erythematosus on disease parameters, quality of life, functional capacity and the risk of atherosclerosis","volume":"15","author":"Rizk","year":"2012","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1177\/0961203309345784","article-title":"Work disability in systemic lupus erythematosus is prevalent and associated with socio-demographic and disease related factors","volume":"18","author":"Baker","year":"2009","journal-title":"Lupus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"452","DOI":"10.3899\/jrheum.160900","article-title":"Charlson comorbidity index is related to organ damage in systemic lupus erythematosus: Data from KORean lupus network (KORNET) registry","volume":"44","author":"Kim","year":"2017","journal-title":"J. Rheumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1177\/0961203314522340","article-title":"The effect of comorbidity on hospital mortality in patients with SLE from an Asian tertiary hospital","volume":"23","author":"Yang","year":"2014","journal-title":"Lupus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/RHU.0000000000000437","article-title":"Comorbid conditions are associated with emergency department visits, hospitalizations, and medical charges of patients with systemic lupus erythematosus","volume":"23","author":"Han","year":"2017","journal-title":"J. Clin. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1002\/acr.20506","article-title":"Association of the Charlson comorbidity index with mortality in systemic lupus erythematosus","volume":"63","author":"Jonsen","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1136\/annrheumdis-2013-205139","article-title":"Treat-to-target in systemic lupus erythematosus: Recommendations from an international task force","volume":"73","author":"Mosca","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1136\/annrheumdis-2013-203249","article-title":"EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases","volume":"72","author":"Duru","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1136\/annrheumdis-2019-215089","article-title":"2019 update of the EULAR recommendations for the management of systemic lupus erythematosus","volume":"78","author":"Fanouriakis","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1136\/ard.2009.117200","article-title":"European League against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies","volume":"69","author":"Mosca","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1136\/annrheumdis-2017-212614","article-title":"Novel gene variants associated with cardiovascular disease in systemic lupus erythematosus and rheumatoid arthritis","volume":"77","author":"Leonard","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1007\/s10067-019-04511-7","article-title":"Burden of comorbidities in South Africans with systemic lupus erythematosus","volume":"38","author":"Greenstein","year":"2019","journal-title":"Clin. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1177\/0961203319884646","article-title":"Does SLE widen or narrow race\/ethnic disparities in the risk of five co-morbid conditions? Evidence from a community-based outpatient care system","volume":"28","author":"Falasinnu","year":"2019","journal-title":"Lupus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1002\/art.1790090613","article-title":"Racial aspects of comorbidity in systemic lupus erythematosus","volume":"9","author":"Walsh","year":"1996","journal-title":"Arthritis Care Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ypmed.2016.04.009","article-title":"Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status","volume":"88","author":"Akinyemiju","year":"2016","journal-title":"Prev. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Schiotz, M.L., Stockmarr, A., Host, D., Glumer, C., and Frolich, A. (2017). Social disparities in the prevalence of multimorbidity\u2014A register-based population study. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4314-8"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1177\/0961203318816820","article-title":"Is systemic lupus erythematosus different in urban versus rural living environment? Data from the Cretan Lupus Epidemiology and Surveillance Registry","volume":"28","author":"Gergianaki","year":"2019","journal-title":"Lupus"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1136\/annrheumdis-2017-211206","article-title":"Epidemiology and burden of systemic lupus erythematosus in a Southern European population: Data from the community-based lupus registry of Crete, Greece","volume":"76","author":"Gergianaki","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1023\/A:1022615816883","article-title":"Community-based medical systems advancement in a hospital-primary health care centre in Crete, Greece: Concepts, methods, and the new role of the general practitioner","volume":"22","author":"Chatziarsenis","year":"1998","journal-title":"J. Med. Syst."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1002\/art.1780400928","article-title":"Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus","volume":"40","author":"Hochberg","year":"1997","journal-title":"Arthritis Rheum."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1002\/art.34473","article-title":"Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus","volume":"64","author":"Petri","year":"2012","journal-title":"Arthritis Rheum."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1097\/01.mlr.0000163658.65008.ec","article-title":"Use of a self-report-generated Charlson Comorbidity Index for predicting mortality","volume":"43","author":"Chaudhry","year":"2005","journal-title":"Med. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3527","DOI":"10.1038\/s41598-019-40072-0","article-title":"Comparison of self-reported and register-based hospital medical data on comorbidities in women","volume":"9","author":"Ho","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1007\/s00296-015-3296-z","article-title":"Comparison of the Charlson Comorbidity Index derived from self-report and medical record review in Asian patients with rheumatic diseases","volume":"35","author":"Ng","year":"2015","journal-title":"Rheumatol. Int."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Olomu, A.B., Corser, W.D., Stommel, M., Xie, Y., and Holmes-Rovner, M. (2012). Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly?. BMC Health Serv. Res., 12.","DOI":"10.1186\/1472-6963-12-398"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_49","first-page":"910","article-title":"Is it primary neuropsychiatric systemic lupus erythematosus? Performance of existing attribution models using physician judgment as the gold standard","volume":"34","author":"Fanouriakis","year":"2016","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.semarthrit.2013.05.003","article-title":"The systemic lupus international collaborating clinics (SLICC) damage index: A systematic literature review","volume":"43","author":"Sutton","year":"2013","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1093\/rheumatology\/keh624","article-title":"BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group\u2032s disease activity index for patients with systemic lupus erythematosus","volume":"44","author":"Isenberg","year":"2005","journal-title":"Rheumatology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.semarthrit.2018.07.012","article-title":"Racial\/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus","volume":"48","author":"Barbhaiya","year":"2019","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"611","DOI":"10.18865\/ed.30.4.611","article-title":"Examining racial differences in access to primary care for people living with lupus: Use of ambulatory care sensitive conditions to measure access","volume":"30","author":"Brown","year":"2020","journal-title":"Ethn. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1002\/acr.23018","article-title":"Risk of myocardial infarction and stroke in newly diagnosed systemic lupus erythematosus: A general population-based study","volume":"69","author":"To","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/acr.20343","article-title":"Obesity and its measurement in a community-based sample of women with systemic lupus erythematosus","volume":"63","author":"Katz","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e000398","DOI":"10.1136\/lupus-2020-000398","article-title":"Disease duration, age at diagnosis and organ damage are important factors for cardiovascular disease in SLE","volume":"7","author":"Nived","year":"2020","journal-title":"Lupus Sci. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.3899\/jrheum.101132","article-title":"Prevalence of and factors associated with hypertension in young and old women with systemic lupus erythematosus","volume":"38","author":"Sabio","year":"2011","journal-title":"J. Rheumatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.3899\/jrheum.161121","article-title":"Evolution of risk factors for atherosclerotic cardiovascular events in systemic lupus erythematosus: A longterm prospective study","volume":"44","author":"Tselios","year":"2017","journal-title":"J. Rheumatol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1093\/aje\/kws130","article-title":"Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus","volume":"176","author":"Magder","year":"2012","journal-title":"Am. J. Epidemiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"549","DOI":"10.2174\/1570161118666191227101636","article-title":"Cardiovascular disease in systemic lupus erythematosus: Recent data on epidemiology, risk factors and prevention","volume":"18","author":"Kostopoulou","year":"2020","journal-title":"Curr. Vasc. Pharm."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1093\/rheumatology\/kez288","article-title":"Initial disease severity, cardiovascular events and all-cause mortality among patients with systemic lupus erythematosus","volume":"59","author":"Li","year":"2020","journal-title":"Rheumatology"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1093\/rheumatology\/ker307","article-title":"Systemic lupus erythematosus risk factors for coronary artery calcifications","volume":"51","author":"Criales","year":"2012","journal-title":"Rheumatology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1097\/HJH.0000000000002368","article-title":"Toll-like receptor 7-driven lupus autoimmunity induces hypertension and vascular alterations in mice","volume":"38","author":"Visitacion","year":"2020","journal-title":"J. Hypertens"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1002\/art.40571","article-title":"Comparison of remission and lupus low disease activity state in damage prevention in a United States systemic lupus erythematosus cohort","volume":"70","author":"Petri","year":"2018","journal-title":"Arthritis Rheumatol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"138","DOI":"10.3389\/fendo.2017.00138","article-title":"Systemic lupus erythematosus and thyroid autoimmunity","volume":"8","author":"Ferrari","year":"2017","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1177\/0961203318805849","article-title":"Association between systemic lupus erythematosus and thyroid dysfunction: A meta-analysis","volume":"27","author":"Luo","year":"2018","journal-title":"Lupus"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Yun, J.S., Bae, J.M., Kim, K.J., Jung, Y.S., Kim, G.M., Kim, H.R., Lee, J.S., Ko, S.H., Cha, S.A., and Ahn, Y.B. (2017). Increased risk of thyroid diseases in patients with systemic lupus erythematosus: A nationwide population-based study in Korea. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0179088"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1177\/0961203316664597","article-title":"Prevalence and associated factors of low bone mass in adults with systemic lupus erythematosus","volume":"26","author":"Cramarossa","year":"2017","journal-title":"Lupus"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e000069","DOI":"10.1136\/rmdopen-2015-000069","article-title":"Systemic lupus erythematosus and fractures","volume":"1","author":"Bultink","year":"2015","journal-title":"RMD Open"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"8112","DOI":"10.3390\/ijerph110808112","article-title":"Atopic diseases and systemic lupus erythematosus: An epidemiological study of the risks and correlations","volume":"11","author":"Hsiao","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1111\/1756-185X.13928","article-title":"Allergic rhinitis and risk of systemic lupus erythematosus: A systematic review and meta-analysis","volume":"23","author":"Wongtrakul","year":"2020","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.autrev.2016.02.003","article-title":"A link: Allergic rhinitis, asthma & systemic lupus erythematosus","volume":"15","author":"Sin","year":"2016","journal-title":"Autoimmun. Rev."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1007\/s00296-019-04423-4","article-title":"Mental disorders in systemic lupus erythematosus: A cohort study","volume":"39","author":"Fernandez","year":"2019","journal-title":"Rheumatol. Int."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1111\/bjd.16831","article-title":"Increased risk of depression in patients with cutaneous lupus erythematosus and systemic lupus erythematosus: A Danish nationwide cohort study","volume":"179","author":"Hesselvig","year":"2018","journal-title":"Br. J. Derm."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.semarthrit.2019.06.017","article-title":"Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis","volume":"50","author":"Moustafa","year":"2020","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"142","DOI":"10.31138\/mjr.28.3.142","article-title":"Prevalence and severity of depression among Iraqi patients with systemic lupus rythematosus: A descriptive study","volume":"28","author":"Gorial","year":"2017","journal-title":"Mediterr. J. Rheumatol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.eurpsy.2017.03.006","article-title":"The association between systemic lupus erythematosus and bipolar disorder\u2014A big data analysis","volume":"43","author":"Tiosano","year":"2017","journal-title":"Eur. Psychiatry J. Assoc. Eur. Psychiatr."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1093\/rheumatology\/ket404","article-title":"Suicidal ideation in patients with systemic lupus erythematosus: Incidence and risk factors","volume":"53","author":"Mok","year":"2014","journal-title":"Rheumatology"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1017\/S2045796016000561","article-title":"Schizophrenia among patients with systemic lupus erythematosus: Population-based cross-sectional study","volume":"26","author":"Tiosano","year":"2017","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1002\/acr.23593","article-title":"Sleep disturbance and depression symptoms mediate relationship between pain and cognitive dysfunction in lupus","volume":"71","author":"Lillis","year":"2019","journal-title":"Arthritis Care Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e11376","DOI":"10.1097\/MD.0000000000011376","article-title":"Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors","volume":"97","author":"Cornaby","year":"2018","journal-title":"Medicine"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s11926-018-0797-2","article-title":"Anxiety and mood disorders in systemic lupus erythematosus: Current insights and future directions","volume":"20","author":"Tisseverasinghe","year":"2018","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e038829","DOI":"10.1136\/bmjopen-2020-038829","article-title":"Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: A study of 5658 UK Biobank participants","volume":"10","author":"McQueenie","year":"2020","journal-title":"BMJ Open"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.semarthrit.2015.06.010","article-title":"Development of a multimorbidity index: Impact on quality of life using a rheumatoid arthritis cohort","volume":"45","author":"Radner","year":"2015","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"7683","DOI":"10.1038\/s41598-020-64732-8","article-title":"Prevalence and pattern of comorbidities in chronic rheumatic and musculoskeletal diseases: The COMORD study","volume":"10","author":"Ziade","year":"2020","journal-title":"Sci Rep."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/0961203320967102","article-title":"Multimorbidity among incident Finnish systemic lupus erythematosus patients during 2000\u20132017","volume":"30","author":"Kariniemi","year":"2021","journal-title":"Lupus"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s10067-019-04776-y","article-title":"Late-onset systemic lupus erythematosus: Characteristics and outcome in comparison to juvenile- and adult-onset patients-a multicenter retrospective cohort","volume":"39","author":"Medhat","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e000346","DOI":"10.1136\/lupus-2019-000346","article-title":"Development of a systemic lupus erythematosus cardiovascular risk equation","volume":"6","author":"Petri","year":"2019","journal-title":"Lupus Sci. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1001\/jamainternmed.2017.1877","article-title":"Association of educational attainment with lifetime risk of cardiovascular disease: The atherosclerosis risk in communities study","volume":"177","author":"Kubota","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Nagel, G., Peter, R., Braig, S., Hermann, S., Rohrmann, S., and Linseisen, J. (2008). The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health, 8.","DOI":"10.1186\/1471-2458-8-384"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1136\/annrheumdis-2013-203779","article-title":"Revisiting comorbidities in gout: A cluster analysis","volume":"74","author":"Richette","year":"2015","journal-title":"Ann. Rheum. Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/5\/998\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:31:13Z","timestamp":1760160673000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/5\/998"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,2]]},"references-count":91,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["jcm10050998"],"URL":"https:\/\/doi.org\/10.3390\/jcm10050998","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,2]]}}}