{
  "abstract": "Objectives To evaluate whether the presence of additional autoimmune diseases (ADs) increases the risk of mortality and organ damage in patients with systemic lupus erythematosus (SLE), using a large single centre cohort with long term follow up.Methods We retrospectively analysed 903 patients with confirmed SLE followed at a dedicated lupus clinic in London from 1978 to 2023. Patients were stratified by autoimmune burden: Group 1 (isolated SLE), Group 2 (SLE + 1 AD), and Group 3 (SLE + 2 or more ADs). Autoimmune comorbidities were diagnosed according to international classification criteria and verified by specialists. The primary outcome was all cause mortality; secondary outcomes included cause specific mortality and cumulative organ damage (SLICC/ACR-SDI). Survival was assessed with Kaplan–Meier curves and log-rank tests, and multivariable Cox proportional hazards models adjusted for age at SLE diagnosis and sex. Logistic regression was additionally used for cross sectional comparisons of vital status at last follow-up. Sensitivity analyses excluded antiphospholipid syndrome (APS) and adjusted for lupus nephritis.Results Of 903 patients, 273 (30.2%) developed equal or more than 1 additional AD, most frequently Sjögren’s syndrome, autoimmune thyroid disease, APS, and myositis. Crude mortality increased with autoimmune burden (17.6% in Group 1, 22.3% in Group 2, and 32.4% in Group 3; p = 0.047). In adjusted Cox models, 2 or more ADs conferred a nearly threefold higher risk of death versus isolated SLE (HR 2.96, 95% CI 1.41–6.03; p = 0.003). Survival differences were significant between Group 1 and Group 3 (log-rank p = 0.029). Organ damage accrued more rapidly in Group 3, with 41% showing SDI equal or more 1 at 12 months compared with 21% in Group 1 (p = 0.028), and differences persisted at 5 and 10 years. Disease-type–specific analyses did not identify any single AD fully accounting for the excess riskConclusions In this long term cohort, the accumulation of multiple autoimmune diseases was independently associated with increased mortality and accelerated organ damage in SLE. These findings highlight autoimmune burden as a composite prognostic factor beyond any single disease entity and underscore the need for early recognition, personalised management, and intensified monitoring of high-risk patients.",
  "authors": [
    {
      "affiliations": [
        "Internal Medicine Department, Parc Taulí University Hospital, Parc Taulí Research and Innovation Institute (I3PT), Barcelona, España"
      ],
      "name": "Javier del Cid Lemus"
    },
    {
      "affiliations": [
        "Centre for Ageing, Rheumatology and Regenerative Medicine. Room 423, The Rayne Building, University College London, 5Univ, London, Reino Unido"
      ],
      "name": "Soon Chin Toh"
    },
    {
      "affiliations": [
        "Centre for Ageing, Rheumatology and Regenerative Medicine. Room 423, The Rayne Building, University College London, 5Univ, London, Reino Unido"
      ],
      "name": "David Isenberg"
    }
  ],
  "title": "LBA:01:10 Autoimmune comorbidity burden and risk of death in systemic lupus erythematosus: a single centre cohort from the United Kingdom",
  "uid": "5e22993c-678b-53ca-aaf4-f63a0be2b0eb"
}