Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by a relapsing-remitting course. Long-term prognosis of SLE patients remains poor . Due to the effect of potent anti-inflammatory and immunosuppressive, glucocorticoids (GCs) remain the cornerstone of treatment in SLE. However, GCs produce several adverse reactions, most are time and dose dependent, limiting their clinical usefulness. Increased longevity with prolonged exposure to GCs and inflammatory insults might contribute to organ damage accrual, which retards further improvement of survival in these patients . Assessment the extent of organ damage caused by SLE has been considered an important part of the assessment of prognosis. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) is a validated instrument designed to measure irreversible damage resulting from SLE disease activity and its treatment. The study of damage accrual in patients with SLE caused by the long-term treatment of GCs is still not clear.In a large SLE cohort, followed prospectively, we determined to investigate the association between damage accrual with GCs, both cumulative prednisone dose and high-dose prednisone. The results of our study could shed more light on the risk/benefit ratio of GCs in long-term maintenance treatment with SLE patients.
Objectives To evaluate the association between long-term glucocorticoids use and damage accrual in patients with systemic lupus erythematosus.
Methods Medical records of 535 SLE patients from Department of Rheumatology and immunology of Anhui Provincial Hospital were reviewed. 512 patients were femal. The cohort's mean age was 38.27±12.84 years with mean disease duration of 7.33±5.75 years. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) scores were noted. (1) Univariate analysis and multivariable regression analysis were performed to determine factors associated with SDI. (2) Analysis were also performed to determine damage associated with cumulative prednisone dose and high-dose of prednisone (exposure to prednisone at a dosage of 60 mg/day for 1 month).
Results (1) Among 535 patients in our cohort only 5 paitents (0.9%) had never been treated with glucocorticoids. A total of 192 patients (35.9%) had been treated with high dose of prednisone. In addition, 86.9% of patients had been treated with hydroxychloroquine. (2) The highest organ damage was musculoskeletal (n=79, 14.8%), followed by skin damage (n=35, 6.5%) and renal (n=28, 5.2%). Ninety patients were diagnosed with hypertension. (3) SDI scores were associated with age of onset, exposure to high-dose prednisone, hypertension.(4) Cumulative prednisone dose was associated with osteoporosis, osteonecrosis and hypertension; exposure to high-dose prednisone was associated with osteonecrosis, lupus nephritis and hypertension.
Conclusions Long-term taking prednisone predicted damage accrual. The most common damage was osteoporosis, osteonecrosis and hypertension.
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Disclosure of Interest None declared