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Characteristics of patients with autoimmune disease overlap differ from patients with SLE alone

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About 38% of patients with systemic lupus erythematosus had a secondary autoimmune disease, and patients with a secondary autoimmune disease differed in age, sex, race and treatment methods, according to recently published research.

Researchers studied data from 1,321 patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren’s syndrome (SS) and/or antiphospholipid syndrome (APS) treated at the Barbara Volcker Center for Women and Rheumatic Disease in New York. Of these patients, 897 (68%) had SLE alone and 424 (32%) one of the four diagnoses combined with another autoimmune disease. Patients with non-autoimmune rheumatic illnesses, including fibromyalgia, gout, osteoarthritis and osteoporosis, were not included.

A second autoimmune disease was present in 38% of patients with SLE, 30% of patients with RA, 52% of patients with SS and 43% of patients with APS. Although concurrent diagnoses of SLE and APS were common, no pattern of overlap of a specific disease was observed, according to the researchers.

Patients with RA alone were less likely to be women compared with those with a second autoimmune disease, and patients with SS alone were more likely to be white.

Results showed patients with SLE and a second autoimmune disease were less likely to receive a corticosteroid or hydroxychloroquine than patients with SLE alone, but patients with RA and a second autoimmune disease were more likely to receive hydroxychloroquine. Additionally, patients with APS and a second autoimmune disease were more likely to receive a corticosteroid, hydroxychloroquine and an immunosuppressant than patients with APS alone. No differences in treatment were seen between patients with SS alone or patients with SS and a second autoimmune disease.

Three patterns of overlap were observed, the most common of which was in patients with two or more well-defined rheumatic autoimmune diseases, whereas patients exhibiting the second pattern of overlap had a rheumatic autoimmune disease and another autoimmune disease such as Crohn’s disease, Hashimoto’s thyroiditis or multiple sclerosis. The third pattern consisted of asynchronous onset of autoimmune disease without a clear sequence in which the rheumatic disease could precede or follow the diagnosis of another autoimmune disease. Little difference was seen in age of patients with RA or APS and a second autoimmune disease, but patients with SLE and a second autoimmune disease were mean 5 years older, and patients with SS and a second autoimmune disease were about mean 3 years younger, according to the researchers. - by Shirley Pulawski

Disclosure: The researchers report no relevant financial disclosures.