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Epidemiology and outcomes
Independent association of glucocorticoids with damage accrual in SLE
  1. Diane Apostolopoulos1,2,
  2. Rangi Kandane-Rathnayake1,
  3. Sudha Raghunath2,
  4. Alberta Hoi1,2,
  5. Mandana Nikpour3 and
  6. Eric F Morand1,2
  1. 1School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
  2. 2Department of Rheumatology, Monash Health, Melbourne, Australia
  3. 3Department of Medicine and Rheumatology, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia
  1. Correspondence to Dr Diane Apostolopoulos; Diane.apostolopoulos{at}monash.edu

Abstract

Objectives To determine factors associated with damage accrual in a prospective cohort of patients with SLE.

Methods Patients with SLE who attended the Lupus Clinic at Monash Health, Australia, between 2007 and 2013 were studied. Clinical variables included disease activity (Systemic Lupus Erythematosus Disease Activity Index-2K, SLEDAI-2K), time-adjusted mean SLEDAI, cumulative glucocorticoid dose and organ damage (Systemic Lupus International Collaborating Clinics Damage Index (SDI)). Multivariate logistic regression analyses were performed to identify factors associated with damage accrual.

Results A total of 162 patients were observed over a median (IQR) 3.6 (2.0–4.7) years. Seventy-five per cent (n=121) of patients received glucocorticoids. Damage accrual was significantly more frequent in glucocorticoid-exposed patients (42% vs 15%, p<0.01). Higher glucocorticoid exposure was independently associated with overall damage accrual after controlling for factors including ethnicity and disease activity and was significant at time-adjusted mean doses above 4.42 mg prednisolone/day; the OR of damage accrual in patients in the highest quartile of cumulative glucocorticoid exposure was over 10. Glucocorticoid exposure was independently associated with damage accrual in glucocorticoid-related and non-glucocorticoid related domains of the SDI.

Conclusions Glucocorticoid use is independently associated with the accrual of damage in SLE, including in non-glucocorticoid related domains.

  • Systemic Lupus Erythematosus
  • Outcomes research
  • Corticosteroids

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/lupus-2016-000157

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    Footnotes

    • Contributors All contributors meet the criteria for authorship and approved the submitted version of the manuscript.

    • Funding The work reported on this manuscript was supported in part by an unrestricted educational grant from Eli Lilly.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Monash Health HREC Ref: 15212L.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.