OBJECTIVES To apply current definitions of Lupus Low Disease Activity State (LLDAS) to a large cohort and evaluate the concordance between LLDAS and the clinical status according to the expert opinion.
Methods A cross-sectional analysis of a prospective multicenter study of SLE patients from seven Spanish Rheumatology Departments with high level of expertise in SLE. We applied the LLDAS definition and evaluated the agreement between the LLDAS and the clinical status according to the expert opinion. Modifications in LLDAS definition were also explored.
Results 508 patients were included (92% women; mean age (±SD): 50.4 years (± 13.7). A total of 267 (54.4%) patients were in DORIS remission and 304 (62.7%) in LLDAS. Remission was the most frequent state considered by the rheumatologist (n=206, 41.6%). Agreement between expert opinion and LLDAS was 71.4%. Most cases (96.1%) in LLDAS, were classified as remission or low activity by the expert. Of the patients that did not fulfill LLDAS, 126 (70.4%) patients were classified as remission/low disease activity (Figure 1). The main reasons for discordance were the presence of new manifestations compared to previous visit and a SLEDAI 2-K >4 (Table 1). The modification of the LLDAS definition excluding the comparison with previous assessment increases the agreement to 82.6% (95% CI: 81.61–83.96%). Decreasing the cutoff point of prednisone dose to 5mg/daily did not change the agreement (Table 2).
Conclusion Almost two thirds of SLE patients were in DORIS remission or in LLDAS. There is a good correlation between LLDAS and the physician’s opinion, particularly for those patients who fulfill LLDAS definition. A modification in LLDAS definition excluding the comparison with previous assessment have an increase in the agreement with the expert opinion.
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