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Corticosteroid use, hypertension predicted organ damage in SLE patients
Hypertension and corticosteroid use were strong predictors of permanent organ damage in patients with systemic lupus erythematosus, according to study results.
Researchers evaluated 2,054 patients (mean age at diagnosis, 33 years; 92% female) with systemic lupus erythematosus (SLE) in the Hopkins Lupus Cohort, a longitudinal study of patients with SLE. Patients were followed up quarterly or more, with an average follow-up of 6.4 years. At cohort entry and during follow-up, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) was calculated based on organ damage that occurred after SLE diagnosis. Damage score at last available follow-up established the relationships between time-invariant patient characteristics and rates of damage accrual. Timing of damage accrual during cohort participation was used to assess the relationships between time-varying patient characteristics. Demographic, clinical, serologic and therapeutic factors were measured.
Michelle Petri
SDI score rate increased at 0.13 per year post-diagnosis. Patients who were older, male, African-American, hypertensive, and had low income, low education, lupus anticoagulant or proteinuria displayed faster rates of organ damage. Patients who were older with more disease activity, low complement, anti-dsDNA, satisfied more ACR-11 criteria and used corticosteroids had a higher damage risk during follow-up; patients using hydroxychloroquine displayed a lower damage risk. Age, hypertension and corticosteroid use were the most important predictors of damage accrual after adjusting for variables.
“Prednisone is poison,” researcher Michelle Petri, MD, MPH, of the rheumatology division at Johns Hopkins University School of Medicine, told Healio.com. “Prednisone is one of the strongest predictors of later organ damage. Other factors — hypertension [and] lupus anticoagulant — are also important.”
“The most important predictor of damage appears to be corticosteroid use. Prophylactic therapy for the lupus anticoagulant and better control of disease activity, without reliance on corticosteroids, may limit future damage,” the researchers concluded.