Background/Purpose: Several cross-sectional studies have shown a progression of atherosclerosis in SLE was associated with activities of SLE but not with glucocorticoid therapy. However, a few evidence showed correlations between the progression of atherosclerosis in SLE and glucocorticoid therapy in longitudinal studies. Moreover, races and regions are known to be important in atherosclerosis. We conducted a longitudinal cohort study to clarify relevant clinical factors to influence the progression of atherosclerosis in Japanese patients with SLE.

Methods: In our cohort of the patients with SLE who regularly visit our department, the patients who underwent echography of the carotid arteries twice or more, with an interval of two years or more, were enrolled into the present study. Atherosclerosis was evaluated with echography of the carotid arteries. A mean of the bilateral intimal carotid artery media thickness (mIMT) was measured with the three-point method (TOSHIBA Xario200, Aplio400). The annual progression rate of mIMT (mIMT/y) was calculated from the difference between the baseline and the subsequent echo studies. We analyzed clinical factors associated with mIMT and mIMT/y using multiple regression analysis. For mIMT, clinical factors assessed in the analysis were as follows: age, disease duration, smoking habits, comorbid conditions, total cumulative prednisolone dosage (tPSL), history of other medications including HMG-CoA inhibitors, SLICC/ACR damage index (SDI), Ankle-Brachial Index, Cardio-Ankle Vascular Index, HbA1c, C-reactive protein, serum creatinine, high density lipoprotein cholesterol, and low density lipoprotein cholesterol at baseline. For mIMT/y, in addition to the factors above, we assessed mean daily prednisolone dosage during the follow-up period (mPSL) and other medications during the follow-up period. The analysis was performed by SPSS version 22. Data were represented as median (25-75 percentile).

Results: Thirty-nine Japanese patients with SLE were recruited in our study. Of these, 35 were women; age, disease duration, tPSL at baseline, and daily prednisolone dosage during the follow-up period (mPSL) were 60 (48-65) years, 25 (12-32) years, 58 (36-82) g and 5.0 (4.0-7.5) mg/day, respectively. The intervals of echo studies were 4.0 (2.7-6.1) years. At baseline, the mIMT was 0.60 (0.50-0.75) mm. Age (B=0.005, SE=0.002, p=0.011) and SDI (B=0.05, SE=0.02, p=0.019) were selected as positive contributory factors for mIMT, while tPSL was selected as a negative factor (B=- 0.002, SE=0.001, p=0.007). For mIMT/y, mPSL (B=-0.005, SE=0.002, p=0.004) was a negative contributory factor, and diabetes mellitus requiring medical therapy was a positive factor (B=0.032, SE=0.014, p=0.035).

Conclusion:  These results suggested that glucocorticoid therapy might be protective against the progression of atherosclerosis in Japanese patients with SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/preventive-effects-of-glucocorticoids-on-progression-of-atherosclerosis-in-japanese-patients-with-sle/