Damage in systemic lupus erythematosus and its association with corticosteroids

Abraham Zonana-Nacach, Susan G. Barr, Laurence S. Magder, Michelle Petri

Research output: Contribution to journalArticle

Abstract

Objective. To evaluate the association between corticosteroid use and organ damage in patients with systemic lupus erythematosus (SLE). Methods. The occurrence and date of organ damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, were determined for 539 patients enrolled in the Hopkins Lupus Cohort Study. The risk of damage associated with the cumulative prednisone dose, high-dose prednisone (≥60 mg/day for ≥2 months), and pulse methylprednisolone (1,000 mg intravenously for 1-3 days) was estimated using Cox proportional hazards regression analyses, controlling for age, race, and sex. Risk estimates for the cumulative prednisone dose were based on a reference dose of 36.5 gm (e.g., 10 mg of prednisone daily for 10 years [or equivalent]). Results. The cumulative prednisone dose was significantly associated with the development of osteoporotic fractures (relative risk [RR] 2.5, 95% confidence interval [95% CI] 1.7, 3.7), symptomatic coronary artery disease (RR 1.7, 95% CI 1.1, 2.5), and cataracts (RR 1.9, 95% CI 1.4, 2.5). Each intravenous pulse was associated with a small increase in the risk of osteoporotic fractures (RR 1.3, 95% CI 1.0, 1.8); however, this result failed to reach statistical significance (P = 0.07). Each 2-month exposure to high-dose prednisone was associated with a 1.2-fold increase in the risk of both avascular necrosis (95% CI 1.1, 1.4) and stroke (95% CI 1.0, 1.5). Conclusion. SLE patients receiving long-term prednisone therapy were at significant risk of morbidity due to permanent organ damage. Additional research is required to determine the relative contributions of SLE disease activity and corticosteroids to the pathogenesis of specific types of organ damage. Furthermore, new steroid-sparing therapies are needed in order to treat disease activity and minimize cumulative and high-dose prednisone exposure.

Original languageEnglish (US)
Pages (from-to)1801-1808
Number of pages8
JournalArthritis and Rheumatism
Volume43
Issue number8
DOIs
StatePublished - 2000

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Systemic Lupus Erythematosus
Prednisone
Adrenal Cortex Hormones
Confidence Intervals
Osteoporotic Fractures
Methylprednisolone
Cataract
Coronary Artery Disease
Cohort Studies
Necrosis
Stroke
Steroids
Regression Analysis
Morbidity
Therapeutics
Research

ASJC Scopus subject areas

  • Immunology
  • Rheumatology

Cite this

Damage in systemic lupus erythematosus and its association with corticosteroids. / Zonana-Nacach, Abraham; Barr, Susan G.; Magder, Laurence S.; Petri, Michelle.

In: Arthritis and Rheumatism, Vol. 43, No. 8, 2000, p. 1801-1808.

Research output: Contribution to journalArticle

Zonana-Nacach, Abraham ; Barr, Susan G. ; Magder, Laurence S. ; Petri, Michelle. / Damage in systemic lupus erythematosus and its association with corticosteroids. In: Arthritis and Rheumatism. 2000 ; Vol. 43, No. 8. pp. 1801-1808.
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abstract = "Objective. To evaluate the association between corticosteroid use and organ damage in patients with systemic lupus erythematosus (SLE). Methods. The occurrence and date of organ damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, were determined for 539 patients enrolled in the Hopkins Lupus Cohort Study. The risk of damage associated with the cumulative prednisone dose, high-dose prednisone (≥60 mg/day for ≥2 months), and pulse methylprednisolone (1,000 mg intravenously for 1-3 days) was estimated using Cox proportional hazards regression analyses, controlling for age, race, and sex. Risk estimates for the cumulative prednisone dose were based on a reference dose of 36.5 gm (e.g., 10 mg of prednisone daily for 10 years [or equivalent]). Results. The cumulative prednisone dose was significantly associated with the development of osteoporotic fractures (relative risk [RR] 2.5, 95{\%} confidence interval [95{\%} CI] 1.7, 3.7), symptomatic coronary artery disease (RR 1.7, 95{\%} CI 1.1, 2.5), and cataracts (RR 1.9, 95{\%} CI 1.4, 2.5). Each intravenous pulse was associated with a small increase in the risk of osteoporotic fractures (RR 1.3, 95{\%} CI 1.0, 1.8); however, this result failed to reach statistical significance (P = 0.07). Each 2-month exposure to high-dose prednisone was associated with a 1.2-fold increase in the risk of both avascular necrosis (95{\%} CI 1.1, 1.4) and stroke (95{\%} CI 1.0, 1.5). Conclusion. SLE patients receiving long-term prednisone therapy were at significant risk of morbidity due to permanent organ damage. Additional research is required to determine the relative contributions of SLE disease activity and corticosteroids to the pathogenesis of specific types of organ damage. Furthermore, new steroid-sparing therapies are needed in order to treat disease activity and minimize cumulative and high-dose prednisone exposure.",
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