AB1052 STEROID USE AND STEROID-RELATED COMPLICATIONS IN A NATION-WIDE COHORT OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN SRI LANKA
Authors: C. Dandeniya, D. Munidasa, K. Deshapriya, N. Aravinthan, M. De Silva, G. Kasthuriratna, U. Dissanayake, U. M. A. H. K. Udagedara, P. Wanigasekara, N. Darshana, B. Parker, I. N. Bruce, H. M. A. Ediriweera
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) is a devastating disease. Complications are related to the disease as well as treatment. Disease severity and organ involvement during the course of illness are comparatively higher in the Sri Lankan population with SLE when compared to the North Americans and Europeans. Steroids are widely used in SLE, and are a significant cause of morbidity. <h3>Objectives:</h3> To assess the pattern of steroid use and defined steroid-related side effects among a national cohort of patients with systemic lupus erythematosus in Sri Lanka. <h3>Methods:</h3> An island-wide, hospital-based, ongoing longitudinal follow-up study is conducted at rheumatology clinics across 14 centers in Sri Lanka. Patients who were diagnosed with SLE for at least 6 months are recruited for the study and followed up for 18 months. The data were extracted from the ongoing data base which includes 352 patients at the time of analysis. Steroid use with regard to the type and dose was analyzed. Presence of cataract, osteoporosis, avascular necrosis of the hip and diabetes mellitus after initiation of steroid therapy were considered as defined steroid related side effects (SEs). Association between current steroid usage and infection status was assessed using chi-square test at a p&lt;0.05 significance level. <h3>Results:</h3> Of the sample of 352, 96.6% (n=340) were females with a mean (SD) age of 35.7 (12.8) years. ACR/EULAR classification criteria of 2019 were fulfilled by the majority of patients (n=314, 89.2%). Nearly 60% (n=212) of patients were on steroid treatment at the time of recruitment with a median (IQR) of 7.5mg (5.0 to 15.0) daily dose of prednisolone. SEs of steroids treatment were reported as follows: avascular necrosis (n=8, 2.3%), diabetes mellitus (n=12. 3.4%), osteoporosis (n=4, 1.1%), and cataract (n=19, 5.4%). At least one SE was reported among 9.9% (n=35). Secondary analysis of data showed that only a limited number of patients had undergone screening for osteoporosis with a DXA scan due to limited resources in the country. Although 25.3% (n=89) of patients did not have a history of exposure to steroids in SLE treatment, 6 patients (6.7%) had similar complications: namely, cataract (n=5), diabetes (n=1) and avascular necrosis (n=1). Rate of infections in the current steroid users during the preceding year was 48.1% while in those who were not on steroids at enrolment, it was 45.7%. Current steroid therapy failed to show a statistically significant association with infection rate (p=0.66). <h3>Conclusion:</h3> Steroid use and associated side effects remain low in the study population in comparison to internationally available data, despite more severe organ and organ system involvement reported in the same cohort in Sri Lanka. This is an impressive feat to have been achieved in a setting with constrained resources. However glucocorticoid-induced osteoporosis may be under-reported due to lack of wide access to DXA scanning. <h3>REFERENCES:</h3> [1] Dandeniya C, Munidasa D, Deshapriya K, et al. AB0610 Characterization of disease severity and organ system involvement in patients with systemic lupus erythematosus in Sri Lanka- establishing a country-wide lupus cohort. Annals of the Rheumatic Diseases 2023;82:1506-1507. [2] Tse SM, Mok CC. Time trend and risk factors of avascular bone necrosis in patients with systemic lupus erythematosus. Lupus. 2017 Jun;26(7):715-722. doi: 10.1177/0961203316676384. Epub 2016 Nov 12. PMID: 27831540. [3] Shaharir SS, Hussein H, Rajalingham S, Mohamed Said MS, Abdul Gafor AH, Mohd R, Mustafar R. Damage in the Multiethnic Malaysian Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts Worldwide. PLoS One. 2016 Nov 15;11(11):e0166270. doi: 10.1371/journal.pone.0166270. PMID: 27846298; PMCID: PMC5112785. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Chathurika Dandeniya: None declared, Duminda Munidasa: None declared, Kalum Deshapriya: None declared, Narani Aravinthan: None declared, Monika De Silva: None declared, Gunendrika Kasthuriratna: None declared, Uthpala Dissanayake: None declared, U.M.Asela Harsha Kumara Udagedara: None declared, Priyani Wanigasekara: None declared, Nuwan Darshana: None declared, Ben Parker: None declared, Ian N. Bruce GSK, Astra-Zeneca, Janssen, GSK, Astra-Zeneca, Aurinia, Lilly, GSK, Astra-Zeneca, Janssen, Hakmana Mudalige Anushka Ediriweera: None declared.