Background and aims To assess the prevalence and validate the effect on damage accrual of the recently defined “Lupus Low Disease Activity State”(LLDAS) in a monocentric cohort of patients with Systemic Lupus Erythematosus (SLE).
Methods We studied 293 Caucasian SLE patients during 7 year follow-up. Disease activity was assessed by SLEDAI-2K and SELENA-SLEDAI physician global assessment (PGA), and damage by SLICC/ACR Damage Index (SDI). Franklyn et al1 definition of LLDAS was applied: (1) SLEDAI-2K≤4, with no activity in major organ systems (renal, central nervous system, cardiopulmonary, vasculitis, fever) and no haemolytic anaemia or gastrointestinal activity; (2) no new lupus activity compared with the previous assessment; (3) a PGA (scale 0–3)≤1; (4) current prednisolone-equivalent dose ≤7.5 mg/day; (5) stable maintenance dose of immunosuppressants.
The effect of different durations of LLDAS (1, 2, 3, 4,≥5 consecutive years) on SDI was evaluated by multivariate logistic regression analysis.
Results The prevalence of LLDAS and damage in the cohort are reported in Table 1.
Patients who spent at least 2 consecutive years in LLDAS had significantly reduced damage accrual compared with patients never in LLDAS (p=0.001). Interestingly, among the 254 patients achieving LLDAS for at least 1 year, 231 (90.9%) had clinical-SLEDAI-2K=0. At multivariate analysis, a LLDAS lasting at least two years was protective against damage (Table 2). Conversely, major independent predictors of damage were cumulative prednisone dose ≥180 mg/month and antiphospholipid antibody syndrome (Table 2).
Conclusions Two consecutive years was the shortest LLDAS duration associated with a decrease in damage progression in Caucasian SLE patients.
Franklyn K, et al. Ann Rheum Dis 2016;75:1615–1621.
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