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S1D:4 Testing different definitions of remission in a monocentric caucasian cohort of sle patients
  1. F Saccon,
  2. M Zen,
  3. M Gatto,
  4. M Larosa,
  5. L Nalotto,
  6. S Bindoli,
  7. L Iaccarino and
  8. A Doria
  1. Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy


Objective To evaluate the prevalence of different definitions of remission and their effect on damage in systemic lupus erythematosus (SLE).

Design and method We considered 293 caucasian SLE patients followed-up for 7 years (2009–2015): 253 (86.3%) were female, mean ±SD disease duration 11.1±7.8 years. Disease activity was assessed by clinical SLEDAI-2K (c-SLEDAI) and damage by SLICC/ACR Damage Index (SDI). We evaluate the effect of different definitions of remission (c-SLEDAI=0; c-SLEDAI ≤1; c-SLEDAI=0 and prednisone ≤5 mg/day; c-SLEDAI ≤1 and prednisone ≤5 mg/day; c-SLEDAI=0 and PGA <0.5; c-SLEDAI ≤1 and PGA <0.5; c-SLEDA I=0 and prednisone ≤5 mg/day and PGA <0.5; c-SLEDAI ≤1 and prednisone ≤5 mg/day and PGA <0.5) and different durations of remission (1, 2, 3, 4, ≥5 consecutive years) on SDI using multiple logistic regression analysis.

Results Frequency of remission achieved during the 7 year follow-up are reported in table 1 according to the different definitions.

The mean increase in SDI and the percentage of patients with increased of SDI from the baseline to the end of follow-up were significantly higher in unremitted and 1 year remitted patients compared with patients with 2-, 3-, 4- and ≥5 year remission, irrespective of the definition of remission. 5 year remitted patients had lower damage compared with 2 year (p<0.01) and 3 year (p<0.01) remitted patients. At multivariate analysis, a remission lasting at least 2 years was an independent predictor of no damage accrual only in the definitions including prednisone intake ≤5 mg/day and/or PGA <0.5 (table 2).

Conclusions The inclusion of PGA <0.5 in the definition reduces the frequency of remission only in the long-term (≥5 year). A sustained remission, regardless of its definition, is associated with a lower chronic damage development. The addition of prednisone ≤5 mg/day and/or PGA <0.5 to c-SLEDAI=0/≤1 increases the ability to predict the absence of damage accrual compared with cSLEDAI=0/≤1 without substantial differences among them.

Abstract S1D:4 Table 1

Proportion of patients achieving different levels of remission according to the duration of remission

Abstract S1D:4 Table 2

Multivariate analysis: predictors of damage accrual over the follow-up

  • Remission
  • Systemic Lupus Erythematosus
  • Outcomes research

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