Glucocorticosteroids Associated with More Disease Damage in Lupus

February 22, 2017

For systemic lupus erythematosus patients prescribed glucocorticosteroids, mortality has been found to be more frequent than in patients not prescribed glucocorticosteroids, researchers say.

For systemic lupus erythematosus (SLE) patients who are prescribed glucocorticosteroids, mortality has been found to be more frequent in the first three years post diagnosis as compared to patients who are not prescribed glucocorticosteroids, researchers writing in Arthritis Care and Research report. (1)

Approximately 88-90 percent of systemic lupus erythematosus patients have been exposed to glucocorticosteroids (2-4) over the course of their disease. It has been well-established that glucocorticosteroids contribute to the accrual of disease damage from osteoporotic fractures, osteonecrosis, coronary artery disease, stroke and cataracts. One previous study (Gladman et al.) found that within the first year of lupus, nearly 60 percent of irreversible damage was “possibly or definitely” associated with glucocorticosteroid use. And, in the later stages of disease, the prevalence of disease damage jumps to 80 percent.

In this new study, Murray B. Urowitz of the University of Toronto and colleagues, set out to assess and define the type and rate of damage occurring in systemic lupus erythematosus patients with and without glucocorticosteroids.

They compared 86 systemic lupus erythematosus patients with no history of having taken glucocorticosteroids to 173 systemic lupus erythematosus patients who were prescribed glucocorticosteroids within six months of an SLE diagnosis and for at least three years. They found that these patients have higher mortality rates and disease damage, such as cataracts and musculoskeletal system damage.

Researchers compared the type, amount, rate and nature of organ damage accrual, mortality, and atherosclerotic comorbidities in systemic lupus erythematosus (SLE) patients who haven’t been prescribed glucocorticosteroids.

Here’s what researchers found: 

  • Patients who did not receive glucocorticosteroids tended to be female and white.
  • Patients who were prescribed glucocorticosteroids had higher disease activity scores at the first medical visit.
  • The overall mortality was higher among patients who were prescribed glucocorticosteroids. This group also accrued more damage overall and at five and eight years, especially in ocular (cataracts) and musculoskeletal (osteoporosis with fragility fractures, and osteonecrosis) components.
  • There was no difference in the frequency of coronary artery disease overall or at each of the time points.

“Comorbidities are recognized as important contributors to reduced quality of life in SLE. As expected, glucocorticosteroid-naive patients did not have as severe disease as those exposed to glucocorticosteroids, and they were treated less often with immunosuppressive medications,” researchers wrote.

 

References:

Barry J. Sheane, Dafna D. Gladman, Jiandong Su, Murray B. Urowitz. “Disease Outcomes in Glucocorticosteroid-Naïve Patients With Systemic Lupus Erythematosus,” Arthritis Care & Research. First published: 27 January 2017. DOI 10.1002/acr.22938

Zonana-Nacach A, Barr SG, Magder LS, Petri M. Damage in systemic lupus erythematosus and its association with corticosteroids. Arthritis Rheum 2000;43:1801–8.

Gladman DD, Urowitz MB, Rahman P, Ibanez D, Tam LS. Accrual of organ damage over time in patients with systemic lupus erythematosus. J Rheumatol 2003;30:1955–9.

Fessler BJ, Alarcon GS, McGwin G Jr, Roseman J, Bastian HM, Friedman AW, et al. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. Arthritis Rheum 2005;52:1473–80.