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A report from Lancet Rheumatology shows that glucocorticoid use contributes to damage accrual in systemic lupus erythematosus (SLE) independent of disease activity.
The authors undertook this study to evaluate the effects of steroid use in SLE, as it often confounds analyses of activity and damage.
This multinational study enrolled adult SLE patients and followed their disease activity measures (by SLEDAI-2K and Physician Global Assessment [PGA] scores), drug use and organ damage (according to the Systemic Lupus International Collaborating Clinics Damage Index - SDI).
A total of 1707 patients were recruited between 2013-17 and followed for a median of 2·2 years. Organ damage accrual events were observed in 255 (15%) patients. Over 82% of patients were exposed to prednisolone.
Factors independently associated with damage accrual included time-adjusted mean prednisolone dose, age at enrolment, and ethnicity (Asian vs non-Asians).
In the overall cohort, glucocorticoid use was independently associated with accrual of irreversible organ damage, measured by Systemic Lupus International Collaborating Clinics Damage Index (SDI), after adjusting for measurable disease activity.
In this study irreversible organ damage was accrued at a similar rate in the subset of patients with inactive disease as in the cohort as a whole. Around two-thirds of patients with inactive disease were exposed to glucocorticoids, and glucocorticoid use was independently associated with organ damage in these patients.
These data underscore the harmful effects of glucocorticoids in SLE. Minimizing steroid use in active SLE remains a challenge and may be dependent on the development of new, effective SLE treatment strategies.