High incidence of steroid complications related to cumulative steroid dose in systemic lupus erythematosus patients over the age of 50

Authors: Hernández D.; Rodríguez A.; Rufino M.; Lorenzo V.; de Bonis E.; González-Posada J.M.; Torres A.

Source: Geriatric Nephrology and Urology, Volume 6, Number 3, 1997 , pp. 141-147(7)

Publisher: Springer

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Abstract:

In 6–20% of patients with Systemic Lupus Erythematosus (SLE), the onset occurs after the age of 50 years. Treatment with large doses of corticosteroids (CS) in these patients may be associated with severe side effects. The aim of this study was to describe the main clinical manifestations of elderly SLE patients and the CS related major complications.

Thirteen elderly (>50 years) SLE patients in one center were followed from 1 to 7 years (mean 4 years). Clinical response and outcome, as well as cumulative dose of prednisone and adverse effects, were recorded throughout the follow-up period. The patients were divided into 2 groups according to the presence (Group I: n = 8) or absence (Group II: n = 5) of major complications (MC) related to CS therapy. Patients in Group I presented the following MC: bacterial pneumonia (six episodes), urosepsis (one), myocardial infarction (one), ischemic stroke (one), hip fracture (one), diabetes mellitus (one), and herpes zoster and multiple bacterial peritonitis on peritoneal dialysis in one patient. In addition, one patient suffered lung epidermoid carcinoma and another breast cancer. Six patients (75%) of Group I died and infection was the cause of death in four. Cumulative dose of prednisone in patients of Group I was significantly higher than Group II (13.4 ± 2.7 vs 0.70 ± 0.37 g; p < 0.01), and all major complications appeared when total amount of steroids administered exceeded 4.5 g. Other clinical data such as serum levels of C3, SLE Disease Activity Index (SLEDAI scores) and follow-up period were similar in both groups. Finally, a similar proportion of Group I and Group 11 patients (50% and 40%, respectively) developed renal failure during the follow-up.

In conclusion, treatment with high dose of corticosteroids may cause life-threatening complications in elderly SLE patients (>50 years). In these patients, a cumulative dose higher than 4.5 g should be avoided or carefully considered.

Keywords: systemic lupus erythematosus; elderly patients; steriud therapy; corticosteroids side effects

Language: English

Document Type: Regular paper

Affiliations: 1: Servicio de Nefrología, Hospital Universitario de Canarias, Tenerife, Spain

Publication date: 1997-01-01

High incidence of steroid complications related to cumulative steroid dose in systemic lupus erythematosus patients over the age of 50

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