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Epidemiology and outcomes
Disease activity patterns over time in patients with SLE: analysis of the Hopkins Lupus Cohort
  1. Noémi Györi1,
  2. Ioanna Giannakou1,
  3. Katerina Chatzidionysiou1,
  4. Laurence Magder2,
  5. Ronald F van Vollenhoven1 and
  6. Michelle Petri2
  1. 1ClinTRID—Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
  2. 2Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  1. Correspondence to Dr Ioanna Giannakou; ioangiannak{at}gmail.com

Abstract

Objective To describe SLE disease activity patterns in the Hopkins Lupus Cohort.

Methods Disease activity was studied in 1886 patients followed-up for 1–28 years. Disease activity patterns were defined using (1) Physician Global Assessment (PGA) and (2) modified SLE Disease Activity Index (M-SLEDAI) as follows: long quiescent (LQ), M-SLEDAI=0/PGA=0 at all visits; relapsing-remitting (RR), periods of activity (M-SLEDAI>0/PGA>0) interspersed with inactivity (M-SLEDAI=0/PGA=0); chronic active (CA), M-SLEDAI>0/PGA>0 at all visits. The pattern of first 3 consecutive follow-up years was determined in 916 patients as: persistent LQ (pLQ), persistent RR (pRR) and persistent CA (pCA), LQ, RR and CA pattern in each of the 3 years, respectively; mixed, at least two different pattern types were identified.

Results The RR pattern accounted for the greatest proportion of follow-up time both by M-SLEDAI and PGA, representing 53.8% and 49.9% of total patient-years, respectively. The second most frequent pattern was LQ based on M-SLEDAI (30.7%) and CA based on PGA (40.4%). For the first 3-year intervals, the mixed pattern type was the most common (56.6%). The pRR was the second most frequent (M-SLEDAI 33.3%, PGA 26.5%), while pLQ (M-SLEDAI 6.4%, PGA 0.7%) and pCA were less frequent (M-SLEDAI 3.7%, PGA 16.3%).

Conclusions The RR pattern was the most prevalent pattern. LQ was achieved in a subset of patients, using the M-SLEDAI. However, the PGA captured mild activity missed on the M-SLEDAI in these patients. Over a 3-year perspective, less than half of patients maintained their original pattern.

  • Disease Activity
  • Systemic Lupus Erythematosus
  • Disease Activity Patterns

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-2016-000192

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    Footnotes

    • Contributors MP acquired the data in the cohort. MP, RFvV, NG, IG, LM and KC contributed to study design, data analysis, interpretation of data and preparation of the manuscript. All authors approved the final version of the manuscript.

    • Funding The Hopkins Lupus Cohort is supported by National Institutes of Health AR 43727.

    • Competing interests None declared.

    • Ethics approval Johns Hopkins University School of Medicine Institutional Review Board.

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

    • Data sharing statement No additional data are available.