Yoshia Miyawaki1,2, Sayaka Shimizu3,4, Yusuke Ogawa5, Ken-Ei Sada6, Yu Katayama6, Yosuke Asano6, Keigo Hayashi6, Yuriko Yamamura6, Sumie Hiramatsu-Asano6, Keiji Ohashi6, Michiko Morishita6, Haruki Watanabe6, Mariko Takano-Narazaki6, Yoshinori Matsumoto6, Nobuyuki Yajima5,7,8, Ryusuke Yoshimi9, Yasuhiro Shimojima10, Shigeru Ohno11, Hiroshi Kajiyama12, Kunihiro Ichinose13, Shuzo Sato14, Michio Fujiwara15, Hajime Yamazaki4, Yosuke Yamamoto5, Jun Wada6, Shunichi Fukuhara4,8,16,17. 1. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan. miyawaki.yoshia.65z@kyoto-u.jp. 2. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan. miyawaki.yoshia.65z@kyoto-u.jp. 3. Institute for Health Outcome & Process Evaluation Research (i-Hope International), Akinono-cho 513, Nakagyo-ku, Kyoto City , Kyoto, Japan. 4. Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan. 5. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan. 6. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan. 7. Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan. 8. Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan. 9. Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. 10. Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan. 11. Center for Rheumatic Diseases, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan. 12. Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, Japan. 13. Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan. 14. Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan. 15. Department of Rheumatology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Japan. 16. Shirakawa STAR for General Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan. 17. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, Maryland, USA.
Abstract
BACKGROUND: While survival of systemic lupus erythematosus (SLE) patients has improved substantially, problems remain in the management of their emotional health. Medium to high-dose glucocorticoid doses are known to worsen emotional health; the effect is unclear among patients receiving relatively low-dose glucocorticoids. This study aims to investigate the association between low glucocorticoid doses and emotional health in lupus low disease activity state (LLDAS). METHODS: This cross-sectional study drew on data from SLE patients in 10 Japanese institutions. The participants were adult patients with SLE duration of ≥ 1 year who met LLDAS criteria at the study visit from April 2018 through September 2019. The exposure was the daily glucocorticoid dose (mg oral prednisolone). The outcome was the emotional health score of the lupus patient-reported outcome scale (range: 0 to 100). Multiple linear regression analysis was performed with adjustment for confounders including disease-related damage, activity, and psychotropic drug use. RESULTS: Of 192 patients enrolled, 175 were included in the analysis. Their characteristics were as follows: female, 89.7%; median age, 47 years (interquartile range (IQR): 37.0, 61.0). Median glucocorticoid dose was 4.0 mg (IQR 2.0, 5.0), and median emotional health score 79.2 (IQR 58.3, 91.7). Multiple linear regression analysis showed daily glucocorticoid doses to be associated with worse emotional health (β coefficient = - 2.54 [95% confidence interval - 4.48 to - 0.60], P = 0.01). CONCLUSIONS: Daily glucocorticoid doses were inversely associated with emotional health among SLE patients in LLDAS. Further studies are needed to determine whether glucocorticoid tapering leads to clinically significant improvements in emotional health.
BACKGROUND: While survival of systemic lupus erythematosus (SLE) patients has improved substantially, problems remain in the management of their emotional health. Medium to high-dose glucocorticoid doses are known to worsen emotional health; the effect is unclear among patients receiving relatively low-dose glucocorticoids. This study aims to investigate the association between low glucocorticoid doses and emotional health in lupus low disease activity state (LLDAS). METHODS: This cross-sectional study drew on data from SLEpatients in 10 Japanese institutions. The participants were adult patients with SLE duration of ≥ 1 year who met LLDAS criteria at the study visit from April 2018 through September 2019. The exposure was the daily glucocorticoid dose (mg oral prednisolone). The outcome was the emotional health score of the lupuspatient-reported outcome scale (range: 0 to 100). Multiple linear regression analysis was performed with adjustment for confounders including disease-related damage, activity, and psychotropic drug use. RESULTS: Of 192 patients enrolled, 175 were included in the analysis. Their characteristics were as follows: female, 89.7%; median age, 47 years (interquartile range (IQR): 37.0, 61.0). Median glucocorticoid dose was 4.0 mg (IQR 2.0, 5.0), and median emotional health score 79.2 (IQR 58.3, 91.7). Multiple linear regression analysis showed daily glucocorticoid doses to be associated with worse emotional health (β coefficient = - 2.54 [95% confidence interval - 4.48 to - 0.60], P = 0.01). CONCLUSIONS: Daily glucocorticoid doses were inversely associated with emotional health among SLEpatients in LLDAS. Further studies are needed to determine whether glucocorticoid tapering leads to clinically significant improvements in emotional health.
Authors: George Bertsias; Dimitrios T Boumpas; Antonis Fanouriakis; Myrto Kostopoulou; Alessia Alunno; Martin Aringer; Ingeborg Bajema; John N Boletis; Ricard Cervera; Andrea Doria; Caroline Gordon; Marcello Govoni; Frédéric Houssiau; David Jayne; Marios Kouloumas; Annegret Kuhn; Janni L Larsen; Kirsten Lerstrøm; Gabriella Moroni; Marta Mosca; Matthias Schneider; Josef S Smolen; Elisabet Svenungsson; Vladimir Tesar; Angela Tincani; Anne Troldborg; Ronald van Vollenhoven; Jörg Wenzel Journal: Ann Rheum Dis Date: 2019-03-29 Impact factor: 19.103
Authors: Meenakshi Jolly; A Simon Pickard; Joel A Block; Rajan B Kumar; Rachel A Mikolaitis; Caitlyn T Wilke; Roger A Rodby; Louis Fogg; Winston Sequeira; Tammy O Utset; Thomas F Cash; Iona Moldovan; Emmanuel Katsaros; Perry Nicassio; Mariko L Ishimori; Mark Kosinsky; Joan T Merrill; Michael H Weisman; Daniel J Wallace Journal: Semin Arthritis Rheum Date: 2012-04-04 Impact factor: 5.532