Association of Daily Glucocorticoid Dose With Worse Patient-Reported Outcomes in Systemic Lupus Erythematosus: Data From the Almenara Lupus Cohort

Objective. To evaluate the association between the daily glucocorticoid (GC) dose and various patient-reported outcomes (PROs) in patients with systemic lupus erythematosus (SLE) who have achieved Lupus Low Disease Activity State (LLDAS). Methods. Patients from a single-center cohort were included. PROs included the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Lupus Quality of Life (LupusQoL), physical and mental component summary scores of the 36-Item Short Form Health Survey (SF-36), and the Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) PRO. Univariable and multivariable generalized estimating equations (GEEs) were performed; the multivariable models were adjusted for possible confounders: age at diagnosis, sex, socioeconomic status, educational level, ethnicity, disease duration, disease activity and damage, and antimalarial and immunosuppressant use. In an alternative analysis, GEE was also performed with patients categorized on the basis of 4 prednisone dose categories: 0, > 0 and ≤ 2.5, > 2.5 and ≤ 5 mg, and > 5 and ≤ 7.5 mg. Results. Three hundred twenty-four patients and 1338 LLDAS visits were included. In the adjusted analysis, the daily GC dose was associated with worse scores in FACIT-F, LFA-REAL PRO, and 4 out of the 8 domains of the LupusQoL. In the alternative analysis, after adjustment, the patients in the high GC dose category had a trend of worse PRO scores in the adjusted analysis, whereas those in the lower GC dose category showed a trend of better PRO scores. Conclusion. The daily GC dose is associated with worse PROs in patients with SLE in LLDAS, even after adjusting for possible confounders.