TOPLINE:

Patients with systemic lupus erythematosus had a high and increasing burden of comorbidities. A distinct cluster of obesity, dyslipidemia, hypertension, stroke, major depression, fibromyalgia, and thyroid disorders was associated with lower chances of achieving sustained remission or a low disease activity state, an effect driven by persistent disease activity and delayed steroid tapering.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 347 patients with active systemic lupus erythematosus (median age, 45.7 years; 92.5% women) to assess whether overall comorbidity burden and specific comorbidity patterns affected the likelihood of achieving remission or a low disease activity state.
• Participants had active disease at inclusion, required treatment initiation or intensification, and were followed up for a median of 5 years.
• A list of 140 comorbidities was compiled from established comorbidity indices and adverse event criteria; the presence of comorbidities was identified and confirmed using multiple sources.
• Serial visits recorded treatments, disease activity scores, flares, and organ damage and assessed attainment of remission or a low disease activity state.

TAKEAWAY:

• The mean comorbidity count rose from 2.5 at inclusion to 3.6 at the last follow‑up (P < .001); higher comorbidity scores were associated with a more than 20% lower likelihood of achieving remission or a low disease activity state.
• Machine learning prioritized eight comorbidities (major depression, fibromyalgia, obesity, dyslipidemia, hypertension, stroke, thyroid disorders, and osteoporosis); all except osteoporosis were negatively associated with achieving remission or a low disease activity state.
• At least one of the seven negatively associated comorbidities was present in 68.6% of patients and was linked to an approximately 55%-60% lower likelihood of sustaining remission or a low disease activity state for at least 50% of follow‑up; this effect was primarily driven by higher disease activity and delayed glucocorticoid tapering.
• Higher comorbidity burden was linked to increased damage accrual (incidence rate ratio, 1.38; 95% CI, 1.11-1.71); this adverse association was progressively attenuated in patients who maintained remission for at least 50% of follow‑up or a low disease activity state for at least 60% of follow‑up.

IN PRACTICE:

“The higher risk of damage accrual in patients with greater comorbidity burden highlights the importance of a comprehensive management strategy that addresses coexisting conditions while optimizing therapy to achieve and sustain treat-to-target goals,” the authors wrote.

SOURCE:

The study was led by Myrto Nikoloudaki, Rheumatology and Clinical Immunology, University of Crete Medical School in Heraklion, Greece. It was published online on March 4, 2026, in RMD Open.

LIMITATIONS:

The retrospective design and no comparator group may have increased risk for misclassification, reporting, and ascertainment bias in comorbidity capture. Comorbidity definitions were not uniformly based on formal diagnostic criteria. Finally, the cohort was exclusively White European, which limited applicability to more diverse populations. 

DISCLOSURES:

The University of Crete Research Account and the Pancretan Health Association provided funding support. Some authors reported consulting fees and/or honoraria, grants, sponsored lecture fees, unrestricted investigational grants, and support for attending meetings from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.