{"title":"系统性红斑狼疮患者的糖皮质激素戒断症状和生活质量","authors":"Matee Karoonkatima, Pongthorn Narongroeknawin, Sumapa Chaiamnuay, Paijit Asavatanabodee, Rattapol Pakchotanon","doi":"10.1155/2023/5750791","DOIUrl":null,"url":null,"abstract":"Background/Objective. Chronic glucocorticoid (GCS) therapy is associated with increased risk of organ damage in systemic lupus erythematosus (SLE). However, discontinuation of low-dose GCS might cause withdrawal symptoms. This study is aimed at identifying GCS withdrawal symptoms and health-related quality of life (HRQoL) among SLE patients. Methods. SLE patients whose prednisolone had been previously withdrawn or taken <5 mg/day were enrolled. Serum morning cortisol levels were collected after 72-hour GCS discontinuation, and low-dose ACTH stimulation test (LDST) was performed. Patient report outcomes (PROs) included SLE-specific quality of life questionnaire (SLEQoL), functional assessment of chronic illness therapy (FACIT), patient health questionnaire (PHQ-9), and Pittsburgh’s sleep quality index (PSQI). Results. Serum morning cortisol of 100 SLE patients was tested. Most patients were female (88%). Seventy-four patients showed remission. The <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mtext>mean</mtext> <mo>±</mo> <mtext>SD</mtext> </math> of prednisolone was <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mn>0.73</mn> <mo>±</mo> <mn>1.08</mn> </math> mg/day. Total SLEQoL and FACIT ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mtext>mean</mtext> <mo>±</mo> <mtext>SD</mtext> </math> ) of all patients were <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M4\"> <mn>67.05</mn> <mo>±</mo> <mn>26.15</mn> </math> and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M5\"> <mn>13.7</mn> <mo>±</mo> <mn>8.87</mn> </math> , respectively. Eighteen percent of patients had moderate-severe depressive symptoms, and 49% were poor sleepers. Adrenal function was determined by LDST in only 39 patients; 5 patients (12.8%) were adrenal insufficiency (AI), and 34 patients were normal adrenal function. Compared to normal adrenal function patients, SLE patients with AI had higher proportion of moderate-severe depressive symptom ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M6\"> <mtext>PHQ</mtext> <mo>−</mo> <mn>9</mn> <mo>></mo> <mn>9</mn> </math> ), but not statistically significant (40% vs. 20.6%, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M7\"> <mi>p</mi> <mo>=</mo> <mn>0.34</mn> </math> ). PROs were comparable between groups. Independent factors associated with SLEQoL were FACIT (adjusted <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M8\"> <mi>β</mi> </math> 1.31, 95% CI 0.76, 1.86, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M9\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ), PHQ-9 (adjusted <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M10\"> <mi>β</mi> </math> 5.21, 95% CI 4.32, 6.09, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M11\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ), and PSQI (adjusted <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M12\"> <mi>β</mi> </math> 4.23, 95% CI 3.01, 5.45, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M13\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ), but not with AI (adjusted <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M14\"> <mi>β</mi> </math> -5.2, 95% CI -33.26, 22.93, 0.71, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M15\"> <mi>p</mi> <mo>=</mo> <mn>0.71</mn> </math> ). Conclusion. SLE patients with previous GCS exposure could experience AI and withdrawal symptoms such as sleep disturbance and depression during discontinuation of low-dose GCS. Fatigue, depression, and poor sleeper were significantly associated with poor SLEQoL.","PeriodicalId":51715,"journal":{"name":"International Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Glucocorticoid Withdrawal Symptoms and Quality of Life in Patients with Systemic Lupus Erythematosus\",\"authors\":\"Matee Karoonkatima, Pongthorn Narongroeknawin, Sumapa Chaiamnuay, Paijit Asavatanabodee, Rattapol Pakchotanon\",\"doi\":\"10.1155/2023/5750791\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background/Objective. Chronic glucocorticoid (GCS) therapy is associated with increased risk of organ damage in systemic lupus erythematosus (SLE). However, discontinuation of low-dose GCS might cause withdrawal symptoms. This study is aimed at identifying GCS withdrawal symptoms and health-related quality of life (HRQoL) among SLE patients. Methods. SLE patients whose prednisolone had been previously withdrawn or taken <5 mg/day were enrolled. Serum morning cortisol levels were collected after 72-hour GCS discontinuation, and low-dose ACTH stimulation test (LDST) was performed. Patient report outcomes (PROs) included SLE-specific quality of life questionnaire (SLEQoL), functional assessment of chronic illness therapy (FACIT), patient health questionnaire (PHQ-9), and Pittsburgh’s sleep quality index (PSQI). Results. Serum morning cortisol of 100 SLE patients was tested. Most patients were female (88%). Seventy-four patients showed remission. The <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M1\\\"> <mtext>mean</mtext> <mo>±</mo> <mtext>SD</mtext> </math> of prednisolone was <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M2\\\"> <mn>0.73</mn> <mo>±</mo> <mn>1.08</mn> </math> mg/day. Total SLEQoL and FACIT ( <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M3\\\"> <mtext>mean</mtext> <mo>±</mo> <mtext>SD</mtext> </math> ) of all patients were <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M4\\\"> <mn>67.05</mn> <mo>±</mo> <mn>26.15</mn> </math> and <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M5\\\"> <mn>13.7</mn> <mo>±</mo> <mn>8.87</mn> </math> , respectively. Eighteen percent of patients had moderate-severe depressive symptoms, and 49% were poor sleepers. Adrenal function was determined by LDST in only 39 patients; 5 patients (12.8%) were adrenal insufficiency (AI), and 34 patients were normal adrenal function. Compared to normal adrenal function patients, SLE patients with AI had higher proportion of moderate-severe depressive symptom ( <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M6\\\"> <mtext>PHQ</mtext> <mo>−</mo> <mn>9</mn> <mo>></mo> <mn>9</mn> </math> ), but not statistically significant (40% vs. 20.6%, <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M7\\\"> <mi>p</mi> <mo>=</mo> <mn>0.34</mn> </math> ). PROs were comparable between groups. Independent factors associated with SLEQoL were FACIT (adjusted <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M8\\\"> <mi>β</mi> </math> 1.31, 95% CI 0.76, 1.86, <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M9\\\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ), PHQ-9 (adjusted <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M10\\\"> <mi>β</mi> </math> 5.21, 95% CI 4.32, 6.09, <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M11\\\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ), and PSQI (adjusted <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M12\\\"> <mi>β</mi> </math> 4.23, 95% CI 3.01, 5.45, <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M13\\\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ), but not with AI (adjusted <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M14\\\"> <mi>β</mi> </math> -5.2, 95% CI -33.26, 22.93, 0.71, <math xmlns=\\\"http://www.w3.org/1998/Math/MathML\\\" id=\\\"M15\\\"> <mi>p</mi> <mo>=</mo> <mn>0.71</mn> </math> ). Conclusion. SLE patients with previous GCS exposure could experience AI and withdrawal symptoms such as sleep disturbance and depression during discontinuation of low-dose GCS. Fatigue, depression, and poor sleeper were significantly associated with poor SLEQoL.\",\"PeriodicalId\":51715,\"journal\":{\"name\":\"International Journal of Rheumatology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2023-11-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Rheumatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2023/5750791\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Rheumatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2023/5750791","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景/目标。慢性糖皮质激素(GCS)治疗与系统性红斑狼疮(SLE)器官损伤的风险增加有关。然而,停用低剂量GCS可能会引起戒断症状。本研究旨在确定SLE患者的GCS戒断症状和健康相关生活质量(HRQoL)。方法。先前停用或服用过5mg /天强的松龙的SLE患者被纳入研究。停用GCS 72小时后采集血清皮质醇水平,并进行低剂量ACTH刺激试验(LDST)。患者报告结果(PROs)包括sle特异性生活质量问卷(SLEQoL)、慢性疾病治疗功能评估(FACIT)、患者健康问卷(PHQ-9)和匹兹堡睡眠质量指数(PSQI)。结果。对100例SLE患者进行了晨间血清皮质醇检测。大多数患者为女性(88%)。74名患者出现缓解。泼尼松龙的平均±SD为0.73±1.08 mg/d。所有患者的SLEQoL和FACIT(平均±SD)分别为67.05±26.15和13.7±8.87。18%的患者有中度至重度抑郁症状,49%的患者睡眠质量差。仅39例患者采用LDST检测肾上腺功能;肾上腺功能不全5例(12.8%),肾上腺功能正常34例。与肾上腺功能正常的患者相比,SLE合并AI患者出现中重度抑郁症状的比例更高(PHQ−9 >9),但无统计学意义(40% vs. 20.6%, p = 0.34)。各组间的PROs具有可比性。与SLEQoL相关的独立因素有:FACIT(校正β 1.31, 95% CI 0.76, 1.86, p <0.001), PHQ-9(调整后的β 5.21, 95% CI 4.32, 6.09, p <0.001)和PSQI(调整后的β 4.23, 95% CI 3.01, 5.45, p <0.001),但与AI无关(调整后的β -5.2, 95% CI -33.26, 22.93, 0.71, p = 0.71)。结论。先前接触过GCS的SLE患者在停用低剂量GCS期间可能出现AI和戒断症状,如睡眠障碍和抑郁。疲劳、抑郁和睡眠不良与低SLEQoL显著相关。
Glucocorticoid Withdrawal Symptoms and Quality of Life in Patients with Systemic Lupus Erythematosus
Background/Objective. Chronic glucocorticoid (GCS) therapy is associated with increased risk of organ damage in systemic lupus erythematosus (SLE). However, discontinuation of low-dose GCS might cause withdrawal symptoms. This study is aimed at identifying GCS withdrawal symptoms and health-related quality of life (HRQoL) among SLE patients. Methods. SLE patients whose prednisolone had been previously withdrawn or taken <5 mg/day were enrolled. Serum morning cortisol levels were collected after 72-hour GCS discontinuation, and low-dose ACTH stimulation test (LDST) was performed. Patient report outcomes (PROs) included SLE-specific quality of life questionnaire (SLEQoL), functional assessment of chronic illness therapy (FACIT), patient health questionnaire (PHQ-9), and Pittsburgh’s sleep quality index (PSQI). Results. Serum morning cortisol of 100 SLE patients was tested. Most patients were female (88%). Seventy-four patients showed remission. The of prednisolone was mg/day. Total SLEQoL and FACIT ( ) of all patients were and , respectively. Eighteen percent of patients had moderate-severe depressive symptoms, and 49% were poor sleepers. Adrenal function was determined by LDST in only 39 patients; 5 patients (12.8%) were adrenal insufficiency (AI), and 34 patients were normal adrenal function. Compared to normal adrenal function patients, SLE patients with AI had higher proportion of moderate-severe depressive symptom ( ), but not statistically significant (40% vs. 20.6%, ). PROs were comparable between groups. Independent factors associated with SLEQoL were FACIT (adjusted 1.31, 95% CI 0.76, 1.86, ), PHQ-9 (adjusted 5.21, 95% CI 4.32, 6.09, ), and PSQI (adjusted 4.23, 95% CI 3.01, 5.45, ), but not with AI (adjusted -5.2, 95% CI -33.26, 22.93, 0.71, ). Conclusion. SLE patients with previous GCS exposure could experience AI and withdrawal symptoms such as sleep disturbance and depression during discontinuation of low-dose GCS. Fatigue, depression, and poor sleeper were significantly associated with poor SLEQoL.