1446: Glucocorticoids Use Is a Major Driver of Self-perceived Depression in Systemic Lupus Erythematosus: Insights from a Large, Prospective and Multicenter Study Using RELESSERPROS Register's Database

Iñigo Rúa-Figueroa¹, JULIA MARTINEZ BARRIO², Norman Jiménez³, Maria Galindo-Izquierdo⁴, Esther Uriarte Isacelaya⁵, Antonio Fernandez-Nebro⁶, Jaime Calvo- Alén⁷, SARA MANRIQUE⁸, Jose Rosas⁹, Rocío Caño-Alameda¹⁰, Javier Narvaez¹¹, Inmaculada Ros¹², Elena Aurrecoechea Aguinaga¹³, Vicente Torrente-Segarra¹⁴, Clara Sanguesa Gomez¹⁵, Mercedes Freire González¹⁶, Eva Tomero Muriel¹⁷, Loreto Horcada¹⁸, Clara Moriano Morales¹⁹, Mireia Moreno²⁰, Carlota Iñíguez²¹, Ricardo Blanco²², Ana Pérez Gómez²³, Jose Luis Andreu-Sánchez²⁴, Sandra Garrote Corral²⁵, Santiago Muñoz²⁶, Gema Bonilla²⁷, Nuria Lozano Rivas²⁸, Carlos Montilla-Morales²⁹, Oihane Ibarguengoitia-Barrena³⁰, Lorena Expósito³¹, Elia Valls-Pascual³², Angela Pecondon-Español³³, Sergio Machin³⁴, Eva Salgado-Pérez³⁵, Celia Erausquin³⁶, TAREK CARLOS SALMAN MONTE³⁷, Raúl Menor-Almagro³⁸, Alejandro Muñoz³⁹, Irene Altabas Gonzalez⁴⁰, Jorge Juan Fragio⁴¹ and Jose-Maria Pego-Reigosa⁴², ¹Rheumatology, Hospital de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain, ²Rheumatology, Gregorio Marañon University Hospital, Madrid, Spain, ³IIRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute., Vigo, Spain, ⁴Rheumatology, University Hospital of 12 de Octubre, Madrid, Spain, ⁵Rheumatology, University Hospital of Donosti, San Sebastián, Spain, ⁶Hospital Regional Universitario de Málaga, Malaga, Spain, ⁷Rheumatology, Bioaraba Research Unit, Hospital Universitario Araba, Vitoria, Spain, ⁸Division of Rheumatology, Hospital Regional Universitario Carlos Haya, Malaga, Spain, ⁹Hospital Marina Baixa, Alicante, Spain, ¹⁰Rheumatology Department, Dr. Balmis University General Hospital, Alicante. Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain, ¹¹Hospital Universitario de Bellvitge, Barcelona, Spain, ¹²Rheumatology Department HUSLL, Palma de Mallorca, Spain, ¹³Department of Rheumatology, Hospital Sierrallana, Torrelavega, Spain, ¹⁴Department of Rheumatology, Hospital de Sant Joan Despí Moises Broggi,, Sant Joan Despí, Spain, ¹⁵Severo Ochoa Hospital, Madrid, Spain, ¹⁶Rheumatology department, Complexo Hospitalario Universitario A Coruña (CHUAC). Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain, ¹⁷Rheumatology, Hospital La Princesa, Madrid, Spain, ¹⁸Hospital de Navarra, Pamplona, Spain, ¹⁹Rheumatology, Hospital Universitario de León, León, Spain, ²⁰Parc Tauli Hospital Universitari, I3PT(UAB), Barcelona, Spain, ²¹Hospital Lucus Augusti, Lugo, Spain, ²²Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ²³Rheumatology, Hospital Principe de Asturias, Alcalá de Henares, Spain, ²⁴Rheumatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain, ²⁵Hospital Ramón y Cajal, Madrid, Spain, ²⁶Hospital Infanta Sofia, Madrid, Spain, ²⁷Department of Rheumatology, Hospital Clínico Universitario La Paz, Madrid, Spain, ²⁸Department of Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain, ²⁹Rheumatology, University Hospital of Salamanca, Salamanca, Spain, ³⁰Galdakao-Usansolo University Hospital, Bilbao, Spain, ³¹Rheumatology Unit, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain, ³²Hospital Universitario Doctor Peset. Alicante, Spain., Valencia, Spain, ³³Hospital Miguel Servet, Zaragoza, Spain, ³⁴CHUIMI, Las Palmas de Gran Canaria, Spain, ³⁵Department of Rheumatology, University Hospital of Ourense, Ourense, Spain, ³⁶Rheumatology Department Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain, ³⁷Hospital del Mar/Parc de Salut Mar-IMIM, Barcelona, Spain, ³⁸Rheumatology, Hospital Jerez, Puerto De Santa María, Spain, ³⁹Hospital universitario Virgen del Rocío, El Viso de Alcor, Spain, ⁴⁰Complejo Hospitalario Universitario de Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Vigo, Spain, ⁴¹Hospital General Universitario Valencia, Valencia, Spain, ⁴²Rheumatology, Hospital do Meixoeiro, Vigo, Spain

Background/Purpose: The prevalence of depression and associated factors in systemic lupus erythematosus (SLE) are not well known and there are no longitudinal studies addressing this relevant subject in SLE.We aimed to evaluate the prevalence of self-perceived depression in patients with SLE and associated factors in a large, multicenter cohort (RELESSER-PROS).

Methods: Prospective longitudinal study. Patients with SLE (1997 ACR criteria) answering positively to the depression question of the Lupus Impact Tracker (LIT) questionary (LITQ7), over 4 years of follow-up (5 annual visits, V1 to V5). Self-perceived depression was addressed as "depression any time" or "depression most of time", according to the kind of answer to the LITQ7 (answers 1,2,3 or 4 and answers 3 or 4 respectively). Only patients with no missing values in the covariates, were included in the multivariable analysis. The following covariates were considered: SLEDAI, age, duration of the disease, SLICC/AR DI (SDI), fibromyalgia, Charlson index, smoking, BMI, menopause, sedentary lifestyle, marital status, unemployment and glucocorticoid (GC) use. Friedman test was used to test if the change in repeated measures. Generalized estimating equation (GEE) models with binomial response, were built exploring the associations of individual longitudinal determinants with longitudinal assessment of depression. The best model was selected using quasi-likelihood under the independence model information criterion

Results: A total of 1463 were included. Mean age: 55 (DS±13) years, 90% were female. Mean duration of the disease: 14 (±8.59) years. Fibromyalgia was present in 5.7% (76/1343). Corticosteroids use ranged from 49.4% to 57%, depending on the visit. Median SLEDAI ranged from 0 to 2 and SDI ranged from 1 to 2.

Prevalence of "depression any time" was 89.9% (1104/1228) and 34.6% (200/578) were in depression "most of time". Up to 26.5% (153/578) answered to LITQ7 "depression most of time" in the five visits; 89.7% of the patients which perceived themselves as depressed at least in 2 out of 5 visits. Only 6.9% of the patients with previous diagnosis of depression answered "0" to the Q7 of LIT ("none of the time").

Patients with "depression any time" develop more damage at V5 than patients without depression (answer to LITQ7=0) (p = 0.00931, T-test). In the GEE binomial analysis considering all the predefined covariates, that included only patients with no missing values for any of them (namely, 155 patients), fibromyalgia (OR 2.79; 95%CI: 1.28-6.05), unemployment (OR 1.95; 95%CI 1.02 -3.73), and GC use (OR 1.88; 95%CI 1.18-2.99) were significant associated with "depression any time".

The best model (according QIC) displayed a statistically significant association only with fibromyalgia (OR 2.90; 95%CI: 1.58-5.33) and GC (OR 1.85; 95%CI 1.17-2.93). (Table 1). Without entering glucocorticoids, SLEDAI turns significant in the model, suggesting collinearity.

Conclusion: The prevalence of self-perceived depression is high in SLE. Longitudinal data analysis suggests a causal relationship between glucocorticoids use, fibromyalgia and self-perceived depression.




I. Rúa-Figueroa: AstraZeneca, 5, GSK, 1, 6; J. MARTINEZ BARRIO: None; N. Jiménez: None; M. Galindo-Izquierdo: None; E. Uriarte Isacelaya: None; A. Fernandez-Nebro: None; J. Calvo- Alén: AbbVie, 2, AstraZeneca, 2, Biogen, 6, BMS, 5, Galapagos, 6, GSK, 2, 6, Lilly, 2, 6, Novartis, 2, 6, Roche, 5, Sanofi, 2; S. MANRIQUE: None; J. Rosas: None; R. Caño-Alameda: None; J. Narvaez: None; I. Ros: Janssen, 6, novartis, 6, Pfizer, 6; E. Aurrecoechea Aguinaga: None; V. Torrente-Segarra: None; C. Sanguesa Gomez: None; M. Freire González: None; E. Tomero Muriel: None; L. Horcada: None; C. Moriano Morales: None; M. Moreno: None; C. Iñíguez: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6; A. Pérez Gómez: None; J. Andreu-Sánchez: None; S. Garrote Corral: None; S. Muñoz: None; G. Bonilla: None; N. Lozano Rivas: None; C. Montilla-Morales: None; O. Ibarguengoitia-Barrena: None; L. Expósito: None; E. Valls-Pascual: None; A. Pecondon-Español: None; S. Machin: None; E. Salgado-Pérez: None; C. Erausquin: AbbVie/Abbott, 12, financial support to assist meetings; T. SALMAN MONTE: None; R. Menor-Almagro: None; A. Muñoz: None; I. Altabas Gonzalez: None; J. Fragio: None; J. Pego-Reigosa: None.