Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus
Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus
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DOI：
10.1093/rheumatology/keu148
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发表时间：
2014-08-01
期刊：
影响因子：
5.5
通讯作者：
Ruiz-Irastorza, Guillermo
中科院分区：
文献类型：
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作者：
Ruiz-Arruza, Ioana;Ugarte, Amaia;Ruiz-Irastorza, Guillermo
Objective.本研究的目的是分析糖皮质激素与SLE损害发生的关系。我们报告了一项观察性队列研究，包括230例SLE患者在诊断时登记，随访5年。使用SLICC损伤指数计算损伤。糖皮质激素相关损害定义为无血管性骨坏死、骨质疏松性骨折、糖尿病或白内障。在第四年随访结束时计算泼尼松剂量（泼尼松-4）。构建分类泼尼松-4变量：无泼尼松，千分之一货币符号7.5 mg/天（低剂量），> 7.5 mg/天（中高剂量）。甲基强的松龙冲击与损伤的关系也进行了测试。到第五年，188名患者（82%）接受了泼尼松治疗。87例患者（37.8%）在5年时出现累积损伤。5年时有损伤的患者接受了更高的平均每日泼尼松-4剂量（10.4 vs 6 mg/天，P < 0.001）。在糖皮质激素所致损害的患者中，平均每日泼尼松-4剂量较高（11 vs 7 mg/天，P = 0.04）。服用中-高剂量泼尼松-4的患者比未服用泼尼松的患者有更高的累积损伤风险[校正比值比（OR）5.39，95% CI 1.59，18.27]。服用中-高剂量泼尼松-4的患者比未服用泼尼松的患者更容易发生糖皮质激素相关损害（校正OR 9.9，95% CI 1.1，84）。低剂量组和未使用泼尼松组之间无差异。静脉注射甲基强的松龙-4的累积剂量与全身或糖皮质激素相关的损害无关。泼尼松对系统性红斑狼疮造成损害。剂量< 7.5 mg/天和甲基强的松龙脉冲与损伤累积无关。
Objective. The aim of this study was to analyse the relationship between glucocorticoids and damage accrual in SLE.Methods. We report an observational cohort study including 230 patients with SLE enrolled at diagnosis with 5 years of follow-up. Damage was calculated using the SLICC damage index. Glucocorticoid-related damage was defined as avascular osteonecrosis, osteoporotic fractures, diabetes mellitus or cataracts. Prednisone doses were calculated at the end of the fourth year of follow-up (prednisone-4). A categorical prednisone-4 variable was constructed: no prednisone, a parts per thousand currency sign7.5 mg/day (low dose), > 7.5 mg/day (medium-high dose). The relationship between methylprednisolone pulses and damage was also tested.Results. By the fifth year, 188 patients (82%) had been treated with prednisone. Eighty-seven patients (37.8%) had accrued damage at 5 years. Patients with damage at year 5 had received a higher mean daily prednisone-4 dose (10.4 vs 6 mg/day, P < 0.001). The mean daily prednisone-4 dose was higher in patients accruing glucocorticoid-attributable damage (11 vs 7 mg/day, P = 0.04). Patients taking medium-high doses of prednisone-4 had a higher risk of accruing damage than those taking no prednisone [adjusted odds ratio (OR) 5.39, 95% CI 1.59, 18.27]. Patients taking medium-high doses of prednisone-4 were more likely to develop glucocorticoid-related damage than those on no prednisone (adjusted OR 9.9, 95% CI 1.1, 84). No differences were seen between patients on low doses and those on no prednisone. The cumulative dose of i.v. methylprednisolone-4 was not associated with global or glucocorticoid-related damage.Conclusion. Prednisone causes damage in SLE. Doses < 7.5 mg/day and methylprednisolone pulses are not associated with damage accrual.