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Epidemiology and outcomes
Remission and low disease activity in systemic lupus erythematosus: an achievable goal even with fewer steroids? Real-life data from a monocentric cohort
  1. Chiara Tani,
  2. Roberta Vagelli,
  3. Chiara Stagnaro,
  4. Linda Carli and
  5. Marta Mosca
  1. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
  1. Correspondence to Dr Marta Mosca; marta.mosca{at}med.unipi.it

Abstract

Objectives To evaluate what proportion of patients fulfil the DORIS definition of remission, the definition of lupus low disease activity state (LLDAS) and LLDAS with a glucocorticoid (GC) dosage ≤5 (LLDAS5) in a longitudinal monocentric cohort of patients with SLE; to identify predictors of sustained remission and LLDAS attainment; to evaluate the effect of sustained remission and LLDAS on damage accrual over a period of 5 years and compare the two conditions in terms of clinical outcomes.

Methods Retrospective analysis of data prospectively collected from patients with SLE followed from 2012 to 2016.

Results 115 patients were included in this analysis. At baseline, 72% of patients were on LLDAS and almost all patients also fulfilled the LLDAS5 definition; 45% of patients were in remission on treatment, 12% were in remission off treatment, 26% were in complete remission on treatment, 2% were in complete remission off treatment. Disease activity at baseline was the strongest predictor of subsequent LLDAS and remission; the presence of joint and cutaneous manifestations was associated with a minor likelihood to achieve LLDAS or remission during follow-up.

Patients in remission and LLDAS for the whole follow-up period accrued significantly less organ damage; on the contrary, patients who maintained all kinds of remissions or LLDAS for less than 50% of the time did not show any differences in damage accrual with respect to the rest of the cohort.

Conclusion Remission and LLDAS, even with reduced GC use, are an achievable goal in clinical practice; sustained LLDAS and remission are both associated with reduced damage accrual.

  • systemic lupus erythematosus
  • remission
  • low disease activity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/lupus-2017-000234

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    Footnotes

    • Contributors CT and MM substantially contributed to the conception of the work. CS, LC and RV participated in the acquisition, analysis and interpretation of data. CT and RV drafted the work. MM critically revised the paper. All authors approved the version of the manuscript submitted.

    • Competing interests None declared.

    • Ethics approval In accordance with the policy of our institution, ethical approval from our Research Ethics Board for this type of study was not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data from the study.