THU0279 Prednisone Therapy is an Independent Cause of Damage Attributable to Steroids in Systemic Lupus Erythematosus
Authors: I. Ruiz-Arruza, A. Ugarte, I. Cabezas, J. A. Medina, M. A. Moran
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> The effect of glucocorticoids on organ damage in lupus has been suggested in previous studies, with some relations described with specific domains. Ideal prednisone doses have not yet been described. <h3>Objectives</h3> To analyse the association of different doses of prednisone with damage attributable to steroids in an observational cohort of patients with systemic lupus erythematosus (SLE) with a follow-up of at lest 5 years. <h3>Methods</h3> Demographic, clinical and therapeutical variables were extracted from our database. Five prednisone-related variables were constructed: the maximum dose (mg/day) received at least for 3 consecutive days during the 1 <sup>st</sup> year, the mean daily dose received at the end of the 1 <sup>st</sup> and 4 <sup>th</sup> year after the diagnosis and a categorical variable based on the mean daily dose at the end of the 1<sup>st</sup> and 4<sup>th</sup> years, with the following categories: no prednisone, up to 7.5 mg/d (low dose), up to 30 mg/d (medium dose) and over 30 mg/d (high dose). Damage attributable to steroids was considered if accrued at any time after the first 6 months up to the 5th year of follow up in any of the following SLICC damage index (SDI) domains: cataracts, avascular necrosis (AVN), osteoporosis and diabetes. We excluded those cases with such damage within the first 6 months. Activity was measured using SLEDAI, with a variable consisting of the mean maximum score during years 1 to 5. <h3>Results</h3> 203/225 (90.2%) patients were women. The mean age (SD) at diagnosis was 35.5 (15) years. 18 (8%) patients had accrued damage attributable to steroids within 5 years after the diagnosis of SLE. The most frequent damage was osteoporosis (7 patients), cataracts (6 patients), AVN (4 patients) and diabetes (2 patients). 1 patient developed cataracts and osteoporosis. As expected, the mean (SD) SDI score increased over time from 0.2 (0.5) at 6 months to 0.6 (0.9) at 5 years. The maximum dose of prednisone received within the 1 <sup>st</sup> year was significantly higher in patients with damage attributable to steroids (42 vs. 25 mg/d, respectively, p=0.012). Likewise, the mean daily dose of prednisone after the 1<sup>st</sup> and 4<sup>th</sup> year was significantly higher in patients with damage: 20 vs. 11 mg/d (p=0.017) and 11 vs. 7 mg/d (p=0.04), respectively. With regard to the different prednisone dose categories up to the end of the 4<sup>th</sup> year, the univariate logistic regression showed an increased risk for damage in patients treated with medium doses vs. those taking no prednisone (OR 7.3, 95% CI 0.9-58), with no difference between the latter and patients receiving low doses (OR 1.7 95%CI 0.18-16). Patients taking high doses were very few (n=4) and were not analysed. Considering the prednisone dose categories at the end of the 1<sup>st</sup> year, only patients taking high doses were at a higher risk of accruing damage than patients not taking prednisone (OR 20.76, 95% 2.32-193). <h3>Conclusions</h3> Prednisone causes cataracts, osteoporosis, avascular necrosis and diabetes in patients with SLE. Long term doses above 7.5 mg/d should be avoided. <h3>Acknowledgements</h3> Zonana-Nacach A et al. Arthritis Rheum 2000;43:1801-8. Thamer M et al. J Rheum 2009;36:560-4. <h3>Disclosure of Interest</h3> None Declared