Childhood-Onset Lupus May Predict Steroid Damage

Little is known about differences in long-term steroid toxicity between adults with cSLE and aSLE.
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San Diego — Adult patients with childhood-onset systemic lupus erythematosus (cSLE) may experience greater steroid-related damage compared with patients who are diagnosed with SLE as adults (aSLE), according to an abstract presented at the 2017 ACR/ARHP 2017 Annual Meeting, held November 3-8.

“cSLE often presents [as] severe disease [and is] managed with high-dose steroids,” wrote lead study investigator Merav Heshin-Bekenstein, MD, from the Division of Pediatric Rheumatology at the University of California San Francisco, and colleagues. “Little is known about differences in long-term steroid toxicity between adults with cSLE and aSLE.”

Investigators obtained patient data from the Lupus Outcomes Study between 2005 and 2012 (N=897) to try and establish whether cSLE adults (n=113) were at a significantly higher risk for steroid-related and total disease damage compared with aSLE participants. Researchers also wished to determine whether adults with cSLE accumulated these damages at a higher rate over time. Investigators used the Brief Index of Lupus Damage at baseline and follow-up (mean=6.3±1.7 years between assessments) to determine SLE-related damage.

The average age for cSLE diagnosis was found to be 14±3 years in this cohort vs. 33±10 years for patients with aSLE. Nearly all patients reported taking steroids at 1 time during their disease course. Although the crude rates of steroid-associated damage between those with cSLE and those with aSLE were not significantly different, an adjusted analysis demonstrated that cSLE participants were more likely to experience damage from steroids compared with patients with aSLE (72% vs 58%, P<.0001, odds ratio 2.0; 95% CI, 1.2-3.4). Both groups experienced significant increases in steroid damage with increased SLE duration. There were no observable differences between mean damage score at baseline or follow-up between the 2 groups.

Investigators of this study suggest a more aggressive approach to “steroid-sparing management strategies during childhood” for the ultimate prevention of “increased risk of steroid-related damage in adulthood.”

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Heshin-Bekenstein M, von Scheven E, Hersh AO, Trupin L, Yelin EH, Lawson E. Childhood-onset predicts increased steroid-related damage among adults with systemic lupus erythematosus. Presented at: ACR/ARHP 2017 Annual Meeting; November 3-8, 2017; San Diego, CA. Abstract 1626.

This article originally appeared on Rheumatology Advisor