title: Independent association of glucocorticoids with damage accrual in SLE.
abstract: OBJECTIVE
  To determine factors associated with damage accrual in a prospective cohort of patients with SLE.
  
  
  METHODS
  Patients with SLE who attended the Lupus Clinic at Monash Health, Australia, between 2007 and 2013 were studied. Clinical variables included disease activity (Systemic Lupus Erythematosus Disease Activity Index-2K, SLEDAI-2K), time-adjusted mean SLEDAI, cumulative glucocorticoid dose and organ damage (Systemic Lupus International Collaborating Clinics Damage Index (SDI)). Multivariate logistic regression analyses were performed to identify factors associated with damage accrual.
  
  
  RESULTS
  A total of 162 patients were observed over a median (IQR) 3.6 (2.0-4.7) years. Seventy-five per cent (n=121) of patients received glucocorticoids. Damage accrual was significantly more frequent in glucocorticoid-exposed patients (42% vs 15%, p<0.01). Higher glucocorticoid exposure was independently associated with overall damage accrual after controlling for factors including ethnicity and disease activity and was significant at time-adjusted mean doses above 4.42 mg prednisolone/day; the OR of damage accrual in patients in the highest quartile of cumulative glucocorticoid exposure was over 10. Glucocorticoid exposure was independently associated with damage accrual in glucocorticoid-related and non-glucocorticoid related domains of the SDI.
  
  
  CONCLUSIONS
  Glucocorticoid use is independently associated with the accrual of damage in SLE, including in non-glucocorticoid related domains.
authors.affiliation: School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia; Department of Rheumatology, Monash Health, Melbourne, Australia.
authors.forename: Diane
authors.initials: D
authors.lastname: Apostolopoulos
authors.affiliation: School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences , Melbourne , Australia.
authors.forename: Rangi
authors.initials: R
authors.lastname: Kandane-Rathnayake
authors.affiliation: Department of Rheumatology , Monash Health , Melbourne , Australia.
authors.forename: Sudha
authors.initials: S
authors.lastname: Raghunath
authors.affiliation: School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia; Department of Rheumatology, Monash Health, Melbourne, Australia.
authors.forename: Alberta
authors.initials: A
authors.lastname: Hoi
authors.affiliation: Department of Medicine and Rheumatology , The University of Melbourne at St Vincent's Hospital , Melbourne , Australia.
authors.forename: Mandana
authors.initials: M
authors.lastname: Nikpour
authors.affiliation: School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia; Department of Rheumatology, Monash Health, Melbourne, Australia.
authors.forename: Eric F
authors.initials: EF
authors.lastname: Morand
keywords: Corticosteroids; Outcomes research; Systemic Lupus Erythematosus