Background Lupus Low Disease Activity State (LLDAS) permits serological activity and activity in several organs including joint, muscle, and mucocutaneous activity, provided SLEDA4-2K is <=4 and other LLDAS criteria are met.
Methods Patients in the Asia-Pacific Lupus Collaboration cohort who were recruited and followed up between 2013 and 2020 who had been in LLDAS at least once were included. However, visits which fulfilled both LLDAS and DORIS remission criteria was excluded. Multivariable Cox regression was used to compare flare (SELENA Flare Index) and damage (SLICC-DI increase >=1) in those with serologic and those with neither serologic nor clinical activity, compared with those in LLDAS who had clinical activity.
Results 2701 patients were included with median 3.5 (1.3–5.9) years of follow-up and 14239 visits in LLDAS but not DORIS remission. These visits included 1280 (9.0%) with clinical activity, 7461 (52.4%) visits with serological activity only, and 5498 (38.6%) visits with neither clinical nor serological activity. The most common presentation of visits with clinical activity was mucocutaneous (38.2%). Among the 2701 patients, 539 (20.0%) had at least one episode of LLDAS with clinical activity (clinical-group), 1481 (54.8%) had LLDAS with serological activity only (serologic-group), and 681 (25.2%) had LLDAS without any clinical or serological activities (neither-group). Multivariable cox regression analysis adjusted for demographic variables showed both types of LLDAS without clinical activity are protectively associated with flares, while LLDAS without clinical or serology activity had the strongest protective association with flare (HR 0.67, 95% CI 0.56–0.80, p<0.0001) (table 1). There was no significant difference in association with damage for LLDAS without clinical and/or serologic activity compared with LLDAS with clinical activity.
Conclusions 80% of patients in LLDAS did not have any clinical activity according to SLEDA-2K. LLDAS without clinical or serologic activity is most desirable given the strongest protective association with flare.
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