Corticosteroids Affect Lupus Patients’ Emotional Health, Daily Activities, Study Says

The relationship between emotional health and work/regular activities of daily living is influenced by the use of corticosteroids in women with systemic lupus erythematosus, a new study shows.

The study, “Cultural and quality-of-life considerations when administering corticosteroids as a therapeutic strategy for African American women living with systemic lupus erythematosus,” was published in the journal Patient Preference and Adherence.

Systemic lupus erythematosus (SLE) occurs more frequently in women compared to men. In particular, African-American women are disproportionately impacted by SLE, with a three-to-four times higher incidence compared to Caucasians. 

Corticosteroids are frequently used to treat patients with SLE, often in high doses for patients with more severe disease. However, corticosteroid use is associated with significant short-term and long-term side effects among SLE patients.

Short-term side effects include elevated mood (steroid euphoria), or steroid psychosis, as well as associated mental deficiencies. Unfortunately, these issues are disproportionately experienced by African-American women and can impact their ability to perform work and activities of daily living.

Daily living activities include tasks such as house cleaning, gardening, cooking, laundry, and grocery shopping.

To date, no studies have investigated the factors that affect health-related quality-of-life (HRQoL), such as emotional health, physical health, and work/regular activities of daily living, in relation to corticosteroid use in a group of African-American women with SLE.

So, researchers used data from the Medical University of South Carolina lupus database to conduct an analysis between confirmed cases of lupus and unrelated Gullah African-Americans (African-Americans from the Sea Islands of South Carolina and Georgia) as controls.

The patient group included 57 Caucasian Americans, 141 Gullah African-Americans, and 86 non-Gullah African-Americans.

Overall, results indicated that physical health has a more significant association with decreased work and regular activities of daily living, compared to emotional health.

Interestingly, researchers found that the relationship between emotional health and work/regular activities of daily living are significantly different among different ethnicities of women with SLE.

Non-Gullah African-Americans were found to have similar emotional health scores when compared to Gullah African-Americans, but lower when compared with Caucasian Americans.

Nonetheless, non-Gullah African-American women with SLE had lower scores for work/regular activities of daily living compared with Gullah African-American and Caucasian American women with SLE.

Results showed that, in general, non-Gullah and Gullah African-American women had high emotional health scores, which is contrary to what is known from SLE literature.

“Our findings suggest there may be emotional health protective factors that are culturally unique among this population of African-American women with SLE residing in the Sea Island regions of coastal South Carolina,” investigators explained.

The cultural factors that could influence this outcome include masking emotion, disease-coping mechanisms, religion, and strong familial and social support.

Next, researchers investigated the influence of corticosteroid use in all participants with SLE and the relationship between emotional health and activities of daily living.

Statistical analysis showed that, after adjusting for corticosteroid use, a significant association was detected between emotional health and work/regular activities of daily living.

“These findings suggest corticosteroid use does influence the strength of the association between emotional health and work/regular activities of daily living,” researchers wrote.

Researchers emphasize that SLE outcomes will be improved if racial and ethnic sociocultural factors are taken into account when administering corticosteroids, as well as when developing therapeutics.

“This study provides novel insight into the cultural differences among African-Americans, their interplay with corticosteroid use, and how these can affect quality-of-life outcomes,” they concluded.