Lupus: childhood onset tied to higher risk for steroid-related damage

  • Semin Arthritis Rheum

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Steroid-related damage in adulthood (such as cataracts and osteoporosis-related fracture) is worse for childhood-onset than adult-onset systemic lupus erythematosus (SLE), independent of disease duration.

Why this matters

  • Findings suggest that aggressive use of steroid-sparing treatment is warranted in childhood-onset SLE.

Study design

  • Prospective cohort of adults with confirmed SLE (n=1035) in the Lupus Outcomes Study (2007-2015).
  • Steroid-related damage and disease-related damage were assessed by the patient-reported Brief Index of Lupus Damage (BILD).
  • Childhood-onset SLE was defined as diagnosis at age
  • Steroid-related damage was defined as cataracts, osteoporosis-related fracture, avascular necrosis, or diabetes mellitus.
  • Funding: None.

Key results

  • Mean duration of participation in cohort was 6.3±1.7 years.
  • No differences between childhood- and adult-onset SLE with respect to disease-related damage and rates of damage accumulation.
  • Adults with childhood-onset SLE were 70% more likely to report steroid-related damage than those with adult-onset SLE (OR, 1.7; 95% CI, 1.1-2.8) in adjusted analysis.
  • Adults with childhood-onset SLE had consistently higher rates of steroid-related damage, although rates were high for both childhood- and adult-onset SLE after ≥20 years' disease duration (78% vs 69%; P=.004).

Limitations

  • Observational design.