Association of glucocorticoid doses and emotional health in lupus low disease activity state (LLDAS): a cross-sectional study

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.

Relation Among Anxiety, Depression, Sleep Quality and Health-Related Quality of Life Among Patients with Systemic Lupus Erythematosus: Path Analysis

“…And the number of SLE symptoms significantly contributed to the quality of life which was consistent with previous study. 29 In agreement with previous study (Ratanasiripong et al), skin manifestations (skin rash alopecia and mucosal ulcers) were the most common symptom among participants, and randomized controlled trials have shown that using cosmetics can mask rashes and improve depression, anxiety and quality of life scores. 30 , 31 Meanwhile, patients with skin involvement also had higher likelihood of having coexisting anxiety and depression.…”

Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study

“…Additionally, we found no reduction in mental disorders within patients who attained a state of low-lupus activity. Subgroup analysis according to intake or not of glucocorticoids yielded similar findings, thus reducing the possibility for a treatment confounding effect [ 57 ]. Our results are in agreement with a longitudinal study of 139 SLE patients which revealed four distinct anxiety trajectories that remained stable and not affected by disease activity over an average period of 30.9 months [ 58 ].…”

Lupus RGMX: Social and Clinical Characteristics and their Contribution to Quality of Life in a Mexican Cohort with SLE

“…QoL, but also in other aspects such as adherence to treatment and self-management of the disease (Dima et al, 2019;Miyawaki et al, 2021;Porta et al, 2020).…”

“…Although effective, the use of glucocorticoids has been related with neuropsychiatric manifestations, such as depression and anxiety, previous studies have observed an inverse association between glucocorticoid dose and emotional health. It is also important to highlight that some of the side effects of their use, besides potential organ damage, are weight gain and other appearance-related effects, which can contribute to self-perception and mental health (Miyawaki et al, 2021; Porta et al, 2020). The sum of all these factors, in addition to physical limiting manifestations such as arthritis or lupus headache, influence the self-perception that the patient has over her health and QoL; which explain why self-perception of health and quality of life are the main variables contributing to QoL in our cohort.…”

“…The sum of all these factors, in addition to physical limiting manifestations such as arthritis or lupus headache, influence the self-perception that the patient has over her health and QoL; which explain why self-perception of health and quality of life are the main variables contributing to QoL in our cohort. To date, correlation between patient own health perception and clinician perception has not been established, still, recent works highlight the importance of considering the patient’s perception, as well as mental health related manifestations, as this can bring under detected needs to the conversation and also have a positive impact, not only in their QoL, but also in other aspects such as adherence to treatment and self-management of the disease (Dima et al, 2019; Miyawaki et al, 2021; Porta et al, 2020).…”