Background Nowadays the lupus treatment strategy is based on background therapy, immunosuppressive drugs and glucocorticoids (GC). Using minimal effective dose of GC only in flares is a recomandation for preventing complications which increase mortality.
Objectives To evaluate SLE clinical and immunological activity in lupus patients during the standard clinical care and analyze GC treatment
Methods We observed Polish cohort of patients with SLE 127 patients (118 female and 9 male) with average age 43±6 years, average disease duration 7,8±5,6 years. All of them were treated with oral and pulse GC and standard immunosuppressive therapies (CTX, MMF, AZT,MTX, CsA). As a background therapy 77% of these patients were on chloroquine or hydroksychloroquine. All patients were assessed according to Systemic Lupus Erythematosus Disease Activity Index assessed by SLEDAI (version 2000) and divided into 5 groups: no GC, low dose, medium dose, high dose and puls GC therapy group. Immunological activity was assessed by anti-dsDNA and C3 and C4 complements levels.
Results In analyzed group 28 of patients wihout GC the average SLEDAI score was 7 and 50% of this pts not revealed any immunological activity. Low dose of GC was used in 50 pts with average SLEDAI score 13 and in 24 pts of this group anti-dsDNA and C3 or C4 levels upper limit were not observed. Medium dose of GC was used in 20 pts with average SLEDAI score 19 and it was contained with high immunological activity in 55% (n=11) of pts. In 27 of pts, high doses of GC including puls therapy were needed, the average SLEDAI score was very high 30 and most of pts from this group 70% were immunologicaly active.
Conclusions In this Polish cohort lupus patients GC doses depended on lupus activity. Minimazing glucocorticoid exposure is an important part of appropriate management of lupus patients. Proper assessment of clinical and immunolgical lupus activity is critically for treatment decisions, especially for long-term GC use.
Disclosure of Interest None declared