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LSO-031 Association of serologic and clinical low disease activity states with outcomes in a large multi-national lupus cohort
  1. Yanjie Hao1,
  2. Shereen Oon1,2,
  3. Ning Li3,
  4. Worawit Louthrenoo4,
  5. Yi-Hsing Chen5,
  6. Jiacai Cho6,
  7. Aisha Lateef6,
  8. Laniyati Hamijoyo7,
  9. Shue Fen Luo8,
  10. Yeong-Jian Wu8,
  11. Sandra Navarra9,
  12. Leonid Zamora9,
  13. Zhanguo Li10,
  14. Yuan An10,
  15. Sargunan Sockalingam11,
  16. Yasuhiro Katsumata12,
  17. Masayoshi Harigai12,
  18. Zhuoli Zhang13,
  19. Madelynn Chan14,
  20. Jun Kikuchi15,
  21. Tsutomu Takeuchi15,
  22. Sang-Cheol Bae16,
  23. Fiona Goldblatt17,
  24. Sean O’Neill18,
  25. Kristine Ng19,
  26. Annie Law20,
  27. Duminda Basnayake21,
  28. Nicola Tugnet22,
  29. Sunil Kumar23,
  30. Michael Tee24,
  31. Cherica Tee25,
  32. Yoshiya Tanaka26,
  33. CS Lau27,
  34. Vera Golder3,
  35. Alberta Hoi3,
  36. Rangi Kandane-Rathnayake3,
  37. Eric Morand3 and
  38. Mandana Nikpour1,2
  1. 1Department of Medicine at St. Vincent’s Hospital Melbourne, the University of Melbourne, Australia
  2. 2Rheumatology Department, St. Vincent’s Hospital Melbourne, Australia
  3. 3School of Clinical Sciences at Monash Health, Monash University, Australia
  4. 4Division of Rheumatology in Department of Internal Medicine, Chiang Mai University Hospital, Thailand
  5. 5Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan
  6. 6Rheumatology Division, University Medical Cluster, National University Hospital, Singapore
  7. 7Division of Rheumatology, Department of Internal Medicine, Padjadjaran University, Indonesia
  8. 8Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taiwan
  9. 9Bone and Joint Center, University of Santo Tomas Hospital, Philippines
  10. 10Department of Rheumatology and Immunology, People’s Hospital Peking University Health Science Center, China
  11. 11Department of Medicine, University of Malaya, Malaysia
  12. 12Institute of Rheumatology, Tokyo Women’s Medical University, Japan
  13. 13Department of Rheumatology and Immunology, Peking University First Hospital, China
  14. 14Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
  15. 15Division of Rheumatology, Department of Internal Medicine, Keio University, Japan
  16. 16Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Republic of Korea
  17. 17Department of Rheumatology, Flinders Medical Centre and Royal Adelaide Hospital, Australia
  18. 18Rheumatology Department, Liverpool Hospital, Australia
  19. 19Department of Medicine, North Shore Hospital, New Zealand
  20. 20Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
  21. 21Division of Nephrology, Teaching Hospital, SriLanka
  22. 22Department of Rheumatology, Greenlane Clinical Centre, New Zealand
  23. 23Department of Rheumatology, Middlemore Hospital, New Zealand
  24. 24Department of Physiology, Philippine General Hospital, University of the Philippines, Philippines
  25. 25Department of Pediatrics, Philippine General Hospital, University of the Philippines, Philippines
  26. 26The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
  27. 27Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Hong Kong, Hong Kong


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.

Abstract LSO-031 Table 1

Association of LLDAS subtypes with subsequent flares and damage accrual by cox regression analysis

  • systemic lupus erythematosus
  • low disease activity state
  • outcomes

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