Disease Outcomes in Glucocorticosteroid-Naive Patients With Systemic Lupus Erythematosus

The phenotype of patients who remain naive of glucocorticosteroids has not been described, and the type and rate of their damage accrual remains largely unknown. The objective of this study was to compare the type, amount, rate, and nature of organ damage accrual, mortality, and atherosclerotic comorbidities in glucocorticosteroid-naive and glucocorticosteroid-exposed patients with systemic lupus erythematosus (SLE).

Inception patients from the University of Toronto Lupus Clinic who had never taken glucocorticosteroids and had a minimum of 3 years of followup were compared to patients who received glucocorticosteroids within the first 6 months of SLE diagnosis and for at least 3 years. All patients had no damage at inception.

A total of 86 glucocorticosteroid-naive and 173 glucocorticosteroid-exposed patients were included. There were more females and whites among the glucocorticosteroid-naive patients, whereas the glucocorticosteroid-exposed patients had higher Systemic Lupus Erythematosus Disease Activity Index 2000 scores on first examination. Overall mortality was higher in the glucocorticosteroid-exposed group, but the deaths occurred late. There was no difference in the frequency of coronary artery disease overall or at each of the time points. Damage accrual was higher in glucocorticosteroid-exposed patients overall and at 5 and 8 years. Individual damage items that were higher in glucocorticosteroid-exposed patients included ocular (cataracts) and musculoskeletal (osteoporosis with fragility fractures, and osteonecrosis) components.

Mortality is more frequent in patients taking glucocorticosteroids for at least the first 3 years of their lupus compared to patients who are glucocorticosteroid-naive. In addition, patients taking glucocorticosteroids accumulate more damage by 5 years of disease, and damage tends to be glucocorticosteroid related, including cataracts and musculoskeletal components.