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Abstract
Purpose To compare disease activity and remission over time in well-characterized patients with systemic lupus erythematosus (SLE).
Methods This study included patients diagnosed with SLE, meeting the 1982 American College of Rheumatology (ACR-82) and/or the 2012 Systemic Lupus International Collaborating Clinics criteria. All patients had been included in the regional SLE cohort ‘Clinical Lupus Registry in Northeastern Gothia’ (KLURING) during the years 2008–2020. Patients with ≥2 years of follow-up, ≥3 visits during the follow-up time and <3 years between successive visits were eligible for the study. Adjusted mean clinical SLE disease activity index 2000 (cSLEDAI; excluding items for low C3/C4 and anti-DNA binding) scores were calculated as an assessment of longitudinal disease activity in order to adjust for the different length of follow-up between successive visits for each patient.1 Area under the curve of cSLEDAI between successive visits was added and divided by follow-up time for each patient. In addition, the percentage of visits where each patient achieved remission according to the DORIS criteria (cSLEDAI=0, Physician Global Assessment <0.5, prednisolone ≤5mg/day and/or stable immunosuppressant treatment) was identified. Spearman’s correlation was applied between percent of visits in DORIS remission and adjusted mean cSLEDAI .
Results In total, 249 of 315 patients (79%) in KLURING met the inclusion criteria for this study. The median follow-up time was 8.5 years (range 2–11.5) and the median number of visits was 9 (range 3–33). The median value for the adjusted mean cSLEDAI was 0.35 (0–7.4). 116 patients (47%) achieved remission at ≥70% of their visits. 43 subjects (17%) were in remission during their entire follow-up. A statistical significant correlation was observed between the percent of visits in remission and adjusted mean cSLEDAI (r: –0.79, p <0.001).
Conclusions The adjusted mean cSLEDAI as well as the DORIS criteria identified a subgroup of patients with longstanding low disease activity or remission during follow-up while considering the varying time between visits as well as Physician Global Assessment and treatment, respectively. Further studies are warranted to clarify the etiopathological mechanisms influencing differences in disease activity in SLE.
Figure 1. Distribution of adjusted mean cSLEDAI, expressed as median, by percentage of visits in DORIS remission.
References
Ibañez D, Urowitz MB, Gladman DD. Summarizing disease features over time: I. Adjusted mean SLEDAI derivation and application to an index of disease activity in lupus. J Rheumatol 2003 Sep;30(9):1977–82.
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