Clinical and immunological features, as well as comorbidities in women with systemic lupus erythematosus and a risk of steroid resistance

Background: one of primary goals of systemic lupus erythematosus (SLE) management is to reduce intake of glucocorticoids (GCs) to a maintenance dose or to withdraw them completely. The long-term GC therapy is associated with an increased number of side effects and complications. Therefore, prediction and management of steroid resistance (SR) are still of interest in patients with SLE Aim: to study clinical and laboratory features, as well as comorbidities associated with a high SR risk in SLE patients. Materials and Methods: the authors studied data in 187 women with SLE aged 18–60 years. Clinical and laboratory manifestations, SLE treatment, as well as structure of comorbidities were compared between patients with high and low SR risks calculated by a proprietary know- how using a developed computer program. Results: a high risk of SR was reported in 100 of 187 patients. Patients with high risk of SR (srSLE) showed higher values of the disease activity indicators such as SLEDAI2K (5.6 vs 3.8; p=0.0006), ANA (1:13510 vs. 1:4013; p=0.01), anti-dsDNA (103.7 vs. 78.4; p=0.04), and serum uric acid (UA) (368±122 μmol/l vs. 320±122 μmol/l; p=0.04) than those with a low risk of SR at the disease onset. Hypertension (47% vs. 26%, p=0.02) and avascular necrosis (8% vs. 2%, p=0.03) were more common in srSLE patients. Moreover, Charlson Comorbidity Index (2.33 vs. 1.69; p=0.02) and an estimated risk of cardiovascular events (QRISK3) (12% vs. 7%; p=0.03) were also higher. These patients received lower GC doses at the disease onset (31.4±21.8 mg vs. 39.7±26.4 mg, p=0.03), and they were prescribed with hydroxychloroquine (84% vs. 66%; p=0.03) and belimumab (9% vs. 2%, p=0.02) on a more frequent basis. Conclusion: as compared with non-SR patients, srSLE ones demonstrate longer duration of the disease, later onset, as well as higher clinical and immunological activity associated with higher comorbidity and cardiovascular risk. srSLE patients received lower doses of GC at the baseline. More often, hydroxychloroquine was the only disease-modifying agent that could be one of the SR risk factors. KEYWORDS: systemic lupus erythematosus, steroid resistance, hyperuricemia, cardiovascular diseases, comorbidity, cardiovascular risk. FOR CITATION: Musiychuk M.M., Gaydukova E.K., Inamova O.V., Aliev D.B., Mushtrenko K.S., Khasanova A.A., Gaydukova I.Z. Clinical and immunological features, as well as comorbidities in women with systemic lupus erythematosus and a risk of steroid resistance. Russian Medical Inquiry. 2025;9(3):146–155 (in Russ.). DOI: 10.32364/2587-6821-2025-9-3-1