Background/Purpose:

The Metabolic Syndrome (MetS) is a clustering of metabolic abnormalities associated with an increased risk of developing diabetes and atherosclerosis, and may add to the increased cardiovascular (CV) risk seen in SLE. We examined the potential impact of markers of inflammation and corticosteroid exposure over time on the prevalence of MetS during the first 2 years of follow-up in an international inception SLE cohort.  

Methods:

Recently diagnosed (<15 months) SLE patients from 30 centres across 11 countries were enrolled into The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis (SLICC-RAS) inception cohort from 2000 onwards. Baseline and annual assessments recorded clinical and laboratory data, and therapeutic exposures. MetS was defined according to the 2009 International Diabetes Federation Consensus Statement. A longitudinal analysis of the first 2 years of follow-up was performed using random effects logistic regression which was time-adjusted and took into account multiple visits. The analysis examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over the first 2 years of follow-up. Variables representing exposure at baseline and follow-up, as well as over-time, were assessed. Significant factors in regression analyses, adjusted for  age, sex, ethnicity, and time, were included in the final model.

Results:

We recruited 1494 patients with a mean (SD) age at enrolment and disease duration of 35.2 (13.4) years and 24.1 (18.0) weeks respectively. The prevalence of MetS was 239/1494 (16%) at enrolment, 193/1065 (12.6%) at year 1 and 207/894 (13.5%) at year 2. The highest prevalence at enrolment was in patients of Korean (30.1%) and Hispanic (31.3%) ethnicity. In multiple regression analyses current corticosteroid use (odds ratio (95% confidence interval) 1.97 (1.35, 2.87)); daily average prednisolone dose (mg) (1.03 (1.02, 1.05)); peak oral prednisolone dose (mg) (1.03(1.02, 1.04)); immunosuppressant use (1.69 (1.25, 2.28)); SLICC/ACR-DI ≥1 (3.14 (2.01, 4.89)); preceding MetS status (7.94 (5.52, 11.42)); active renal disease  (2.76 (1.89, 4.03)) and higher SLEDAI-2K (1.06 (1.03, 1.09)) were associated with MetS. Anti-malarial use was protective (0.45 (0.32, 0.63)). In the final model preceding MetS status, higher peak corticosteroid dose (mg) at enrolment, elevated anti-dsDNA at enrolment, increasing age, and Hispanic ethnicity were all independently associated with MetS over time (Table 1).

Table 1: Random effects model of MetS predictors over time in SLICC-RAS

Variable	Adjusted OR (95% CI)
Preceding MetS  (y/n)	4.83 (2.93, 7.87)
Peak prednisolone dose at enrolment (mg)	1.02 (1.01, 1.03)
Elevated anti-dsDNA at enrolment (y/n)	1.86 (1.19, 2.81)
Age (years)	1.03 (1.01, 1.05)
Hispanic ethnicity	3.47 (1.76, 6.86)

Conclusion:

The risk of developing MetS can be determined early in the SLE disease course, with subsets of patients more prone to MetS. Higher doses of steroids in very early disease influence the development of MetS over the subsequent 2 years. Therefore even from disease onset, steroid doses should be individually tailored in order to minimise longer-term CV risk.

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-corticosteroid-doses-early-in-disease-have-a-long-term-influence-on-metabolic-syndrome-in-systemic-lupus-erythematosus-data-from-an-international-inception-cohort/