L. Kobak, O. Abrahamovych, U. Abrahamovych, R. Ivanochko, V. Chemes

Danylo Halytsky Lviv National Medical University

Introduction. Systemic lupus erythematosus (SLE) is a disease with numerous clinical manifestations and an unpredictable course. It often lasts for several months or years, with alternating remissions and exacerbations. Multiple organs can be affected simultaneously with varying degrees of severity, resulting in treatment- and disease-related comorbidities, including circulatory system diseases, which are one of the leading causes of death of SLE patients.

The aim of the study. To find out the nature and frequency of the circulatory system organs comorbid lesions in patients with systemic lupus erythematosus, to characterize them depending on the gender, age and the disease duration.

Materials and methods. Prior to performing the study all patients signed the voluntary consent to participate in accordance with the requirements of Helsinki Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine. The cohort under investigation included 112 patients with diagnosed SLE of different  severity with preliminary stratification as follows: females 89.29 %, patients of working age (57.14 % – young and 39.29 % – middle aged), unemployed (58.04 %), III disability group patients (45.54 %), city residents (62.50 %). According to the results of the disease duration assessment, a significant number of patients with SLE and circulatory system organs comorbid lesions have been ill for 1–5 years (36.61 %) and more than 10 years (38.39 %). All of them were patients of the rheumatology department of the Communal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” from 2016 to 2021.The research was carried out in several stages, during which the nature and frequency of the circulatory system comorbid lesions with respect to gender, age and disease duration were estimated.

Results. While completing the study, almost half of patients with SLE were diagnosed with Raynaud’s syndrome, mitral valve insufficiency and atherosclerosis, about 1/3 – with myocarditis, retinal angiopathy, symptomatic arterial hypertension and livedo reticularis. The varicose veins of the lower extremities, hypertensive disease, diffuse cardiosclerosis, tricuspid valve insufficiency, vein thrombosis, post-thrombophlebitis syndrome, aortic valve insufficiency, capillaritis, pulmonary hypertension, coronary artery disease (CAD) including stable angina pectoris, cardiomyopathy and post-infarction cardiosclerosis were found with the decreasing frequency.

Raynaud’s syndrome was significantly more often diagnosed in females and young people; retinal angiopathy, livedo reticularis and symptomatic arterial hypertension – in females and those patients whose SLE lasted for more than 10 years; myocarditis, varicose veins of the lower extremities – in males; capillaritis – in patients with the shortest duration of SLE; atherosclerosis and mitral valve insufficiency – in elderly patients and patients with SLE lasting for 6–10 years; vein thrombosis and stable angina – in elderly patients and those with SLE lasting for more than 10 years; hypertensive disease, diffuse cardiosclerosis, aortic valve insufficiency, post-infarction cardiosclerosis were the most characteristic for the elderly patients with SLE.

Conclusions. In patients with systemic lupus erythematosus, a number of circulatory system organs comorbid lesions were found. Having studied their nature and frequency, characterizing them depending on gender, age and the disease duration, we found out the certain features that should be taken into consideration during the screening examination of circulatory system disorders in patients with systemic lupus erythematosus and providing them the integrated care to improve their life quality. With this in mind, systemic lupus erythematosus requires further detailed study.

References

1. Abrahamovych O, Fayura O, Abrahamovych U. Comorbidity: a Modern View on the Problem; Classification (first notice). Lviv Clinical Bulletin. 2015;4(12):56-64 (Ukrainian).
2. Abrahamovych UO, Abrahamovych OO, Farmaha ML, Romaniuk OT, Kobak LO. Pаthogenetic association of vascular and cardiac lesions with systemic lupus erythematosus: charasteristics and prevalence. Art of Medicine. 2020;2(14):6-15 (Ukrainian).
3. Chen J-H, Lee CT-C. Explore comorbidities associated with systemic lupus erythematosus: a total population-based case-control study. QJM: An International Journal of Medicine. 2022;115(1):17-23.
4. Gonzalez LA, Alarcon GS. The evolving concept of SLE comorbidities. Expert Rev Clin Immunol. 2017;13:753-768.
5. Kobak L, Abrahamovych O, Abrahamovych U, Chemes V. Modern View on the Problem of Systemic Lupus Erythematosus with and without Comorbid Lesions of the Circulatory System (Literature Review, Clinical Case Description) – First Notice. Lviv Clinical Bulletin. 2021;1(33) – 2(34):37-50 (Ukrainian).
6. Kovalenko VM, Rekalov DG, Yatsyshyn RI et al. Systemic lupus erythematosus (clinical guidelines). K.: Ukrainian Association of Rheumatologists; 2020. 74 p. (Ukrainian).
7. Kuo CF, Chou IJ, Rees F, et al. Temporal relationships between systemic lupus erythematosus and comorbidities. Rheumatology. 2019;58:840-848.
8. Lewis MJ, Jawad AS. The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology. 2017;56(1):67-77.
9. Luo S, Kuo C. Сomorbidities in patients with systemic lupus erythematosus prior to and following diagnosis: case-control study. Lupus Science & Medicine. 2017;4(1).
10. Pons-Estel GJ, Ugarte-Gil MF, Alarcon GS. Epidemiology of systemic lupus erythematosus. Expert Rev Clin Immunology. 2017;13(8):799-814.
11. Rees F, Doherty M, Grainge M, et al. Burden of Comorbidity in Systemic Lupus Erythematosus in the UK, 1999-2012. Arthritis Care Res. 2016;68:819-827.
12. Rees F, Doherty M, Grainge M et al. The incidence and prevalence of systemic lupus erythematosus in the UK, 1999-2012. Ann Rheum Dis. 2016;75(1):136-141.
13. Rekalov DG. Management of systemic lupus erythematosus – 2020: a modern view on the problems. Medical newspaper “Health of Ukraine of the 21st Century”. 2020;23(492):55-57 (Ukrainian).
14. Stojan G, Petri M. Epidemiology of systemic lupus erythematosus: an update. Curr Opin Rheumatol. 2018;30(2):144-150.
15. Yaremenko OB. Immunological studies in systemic rheumatic diseases. Health of Ukraine. 2013;5:71-74 (Ukrainian).
16. Yu C-Y, Kuo C-F, Chou I-J, et al. Comorbidities of systemic lupus erythematosus prior to and following diagnosis in different age-at-onset groups. Lupus. 2022;31(8):963-973.