title: Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus.
abstract: 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, ≤7.5 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.
  
  
  CONCLUSIONS
  Prednisone causes damage in SLE. Doses <7.5 mg/day and methylprednisolone pulses are not associated with damage accrual.
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain.
authors.forename: Ioana
authors.initials: I
authors.lastname: Ruiz-Arruza
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain.
authors.forename: Amaia
authors.initials: A
authors.lastname: Ugarte
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cabezas-Rodriguez
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain.
authors.forename: Jose-Alejandro
authors.initials: JA
authors.lastname: Medina
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Moran
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, The Basque Country, Spain. r.irastorza@euskaltel.net.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
mesh_terms: D000328:Adult; D002386:Cataract / Q000139:chemically induced*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000139:chemically induced*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced*; D058866:Osteoporotic Fractures / Q000139:chemically induced*; D011241:Prednisone / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D011241:Prednisone
keywords: avascular osteonecrosis; cataract; diabetes mellitus; glucocorticoids; methylprednisolone; osteoporosis; prednisone; systemic lupus erythematosus