Incidence of steroid-related damage in Korean patients with Systemic lupus erythematosus, compared to general population, 2002-2015: A retrospective cohort study

초록

Background: Although high risk of steroid-related damages associated with long-term use of steroids for treatment of systemic lupus erythematosus (SLE) have been reported, the magnitude of incidence of the steroid-related damage has not been well established. Objectives: To quantify incidence of steroid-related damage in patients with SLE. Methods: We conducted a cohort study using the National Health Insurance Service-National Sample Cohort database of Korea from 2002 to 2015. We assessed steroid-related damage in patients with SLE (at least one diagnosis of M32 with rare disease registration code V136 during 2004~2009 and without history of steroid-related damage compared by general population. General population was defined as people with no rheumatic diseases. Steroid-related damage was defined as incident diagnosis of avascular necrosis (AVN) (at least one diagnosis of M870x, M871x, M872x, M873x, M878x, M879x, M905x during 2010~2015), osteoporotic fracture (OF) (at least one diagnosis of S720, S721, S722, S422, S52 during 2010~2015). Study population were followed up until incident diagnosis of steroid-related damage or up to December 2015. Age- and sex- standardized incidence ratios (SIRs) for steroid-related damage were calculated. Results: A total of 566 Systemic lupus erythematosus (SLE) and 1,068,973 general population were included in this study. IR of steroid-related damage was 5.9 [4.1-8.4] per 1,000 person-years in SLE patients. Also, IR of steroid-related damage was 2.8 [2.8-2.9] per 1,000 person-years in general population. Comparing SIR in SLE patients, general population by sex, SIR was 1.8 [1.3-2.6] in female. Comparing them by age, SIR was 4.9 [4.6-5.2] in their 10's, 10.8 [10.2-11.4] in their 20's years, 6.8 [6.5-7.1] in their 30's, 2.1 [2.0-2.2] in their 40's, 1.4 [1.36-1.44] in their 50's, 2.3 [2.2-2.4] in their 60's and 2.5 [2.4-2.6] in their 70's. Conclusions: Female patients with SLE, especially 20~39 years, have an increased risk of steroid-related damage compared to general population.