Session Type: Abstract Submissions (ACR)
The University of Toronto Lupus Clinic (UTLC) recently described the phenotype of a group of inception patients with SLE who remained naïve of corticosteroid (CS-naïve) for the entire duration of follow-up at the Clinic. One third of those CS-naïve SLE patients accrued damage over time, yet developed less damage and at a slower rate than those exposed to CS.
We have identified a group of patients who remained CS-naïve for at least 3 years but who later required CS intervention. Below we describe the clinical features of this subset of patients.
Patients with SLE attending the UTLC satisfying the following criteria were included in the study: 3 years or more of follow-up from inception, no exposure to CS for the first 3 years from inception, no organ damage (as per the SLICC Damage Index (SDI) = 0) from inception and at least 5 follow-up visits. Two groups were identified from this cohort: those who remained entirely CS-naïve up to their last visit (CS-naïve) and those exposed to CS at some point after 3 years during follow-up (CS-late). Differences between the 2 groups were examined: in disease activity at inception (SLEDAI-2K) and over time (adjusted mean SLEDAI (AMS)), in the time to first incidence of organ damage (SDI ≥ 1), and the effect of exposure to anti-malarial (AM) medication on organ damage accrual (SDI ≥ 1).
In the CS-late group, 31 patients were identified and 59 in the CS-naïve. The mean time to first CS exposure in the CS-late group was 9.0 ± 5.6 years.
Comparing the CS-late vs. CS-naïve groups, sex distribution (93.6% vs. 94.9% female), mean age at diagnosis (33.3 ± 11.9 vs. 37.8 ± 14.5 years; p = 0.15), years of follow-up (9.1 ± 5.6 vs. 11.0 ± 6.4 years; p = 0.15), mean SLEDAI at first visit (5.68 ± 3.31 vs. 5.25 ± 3.69; p = 0.59), AMS for the first 3 years, time to first damage (3.7 ± 3.9 vs. 4.8 ± 3.1 years; p = 0.36), damage scores over 10 years of follow-up, and the proportion eventually developing damage (11 (35.5%) vs. 23 (39%); p = 0.74) were similar between groups.
73.3% of the CS-late and 50.9% of the CS-naïve received a score on the SLEDAI for immunological activity (p = 0.04), with a mean immunological score of 2.00 ± 1.49 and 1.25 ± 1.38, respectively (p = 0.02). The CS-late had a lesser number with musculoskeletal (MSK) activity (16.1%) at first visit, compared with the CS-naïve group (27.1%; p = 0.24) with lower MSK scores (0.65 ± 1.50 and 1.08 ± 1.79, respectively; p = 0.25). Arthritis and lupus rash were the cause of CS requirement in the CS-late group in most cases.
AM medication did not delay the onset of organ damage in the CS-late group.
A small group of patients with SLE remain steroid treatment naïve for more than 9 years and then develop a requirement for steroids usually because of arthritis and rash. Patients requiring late intervention with CS have greater immunological activity at baseline than patients who remain CS-naïve, yet accrue damage at similar rates to the CS-naïve. Early AM prescription is not protective of late CS requirement or development of organ damage.
B. J. Sheane,
D. D. Gladman,
M. B. Urowitz,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lupus-patients-requiring-first-corticosteroid-intervention-late-in-disease-course-a-phenotypic-description/