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25 Disease modification in SLE: an introduction
  1. Ronald van Vollenhoven
  1. Amsterdam University Medical Centers, and Amsterdam Rheumatology and Immunology Center, The Netherlands


The concept of disease modification is well-established in diverse diseases such as rheumatoid arthritis (RA), Alzheimer’s disease, and asthma. In RA, the concept was initially introduced to distinguish the effects of acetylsalicylic acid and non-steroidal anti-inflammatory drugs, which had been shown to ameliorate joint pain but not to prevent erosive damage to the joint structures, from those of a heterogeneous group of medications that were able to accomplish both goals and were henceforth designated ‘disease-modifying antirheumatic drugs (DMARDs)’. While gold compounds were initially the main drugs in this category, methotrexate eventually was established as the main DMARD for RA.

In the other diseases, the concept of disease modification was defined differently, based on the characteristics of that disease. Therefore, it was of interest to investigate the commonalities between these definitions, with a view to develop an evidence- and consensus-based definition of disease modification for treatments in lupus.1

Based on a systematic review of the literature and extensive discussions, an international task force arrived at such a definition, the main ingredients of which are demonstrated efficacy with respect to established disease activity indices, as well as with respect to organ damage outcomes.

The task force believes that establishing a definition of disease modification in systemic lupus erythematosus will help to clarify which treatments can be considered disease modifying. This will help to harmonise future clinical trial outcomes and enable comparison between therapies, all of which could ultimately help to improve patient outcomes.


  1. van Vollenhoven R, et al. Conceptual framework for defining disease modification in systemic lupus erythematosus: a call for formal criteria. Lupus Sci Med. 2022 Mar;9(1):e000634. doi: 10.1136/lupus-2021-000634.

Learning Objectives

  • Explain the concept of disease modification as they are applied to other diseases

  • Discuss the proposed definition of disease modification in SLE

  • Describe the potential utility of a definition of disease modification in SLE

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