The Association Of Long-term Glucocorticoids Treatment And Organ Damage In Patients With SLE

Objective: To evaluate the association of long-term glucocorticoids(GCs)treatment and organ damage in patients with systemic lupus erythematosus(SLE).Methods: Medical records of 535 SLE patients from Department of Rheumatology and immunology of Anhui Provincial Hospital were reviewed.512 patients were females.The mean age of this cohort 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(SLICC/ACR)Damage Index 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 more than 1 month).Results:(1)Among 535 patients in our cohort only 5 patients(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(HCQ).(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(LN)and hypertension.Conclusion: Long-term GCs treatment predicted organ damage.The most common damage was osteoporosis,osteonecrosis and hypertension.Objective:To investigate the effect of long-term low-dose prednisone administration on bone mineral density(BMD)in inactive systemic lupus erythematosus(SLE).Methods 118 inactive female SLE patients with long-term administration of low-dose prednisonewere recruited from the Department of Rheumatology and Immunology of Anhui Provincial Hospital.All patients used low dose of prednisone for long-term(≤10mg/d,more than half a year).According to the dose of the prednisone,all the subjectswere divided into two groups,group A(dose of the prednisone≤7.5mg/d)and group B(dose of the prednisone 7.5~10mg/d).All the subjectswere also divided into four groups according to the duration,groupⅠduration≤3 years,groupⅡ3 years <duration≤5 years,group Ⅲ 5 years <duration≤10years and group Ⅳduration>10 years.29 normal controls were also recruited.The BMD was measured by dual energy X-ray absorptiometry.The association of bone mineral density with duration and dose of prednisone was compared between different groups.Results:The incidence of osteopenia in 118 female patients with SLE was 42.4%,and the incidence of osteoporosis was 14.4%.In group A and group B,the BMD of all the detection sites were significantly lower than that in normal control group(P(27)0.05).When compared with normal control respectively,the BMD of all the detection sites in groupⅠ,group II,group III and group IV were significantly decreased(P(27)0.05).The BMD of all the detection sits in IV group was lower than that in group I,group II and group III,the differences were statistically significant(P(27)0.05).Multiple logistic regression analysis showed that the high cumulative prednisone dose was the risk factor for osteopenia,while calcium and alfacalcidol using were protective factors of BMD.Conclusion:Inactive SLE patients with long-term use of low dose prednisone resulted in varying degrees of BMD decreased.The lumbar spine and femoral neck had the highest incidence of osteopenia.Long-term taking prednisone,even less than7.5mg/d,can also result in osteopenia.Calcium and alfacalcidol using were protective factors of BMD.