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Characterisation and outcomes of different subsets of low disease activity states in patients with systemic lupus erythematosus

Hao Y 1 , Hansen D 2 , Louthrenoo W 3 , Chen YH 4 , Cho J 5 , Lateef A 6 Show all authors , Hamijoyo L 7 , Luo SF 8 , Wu YJ 9 , Navarra S 10 , Zamora L 11 , Li Z 12 , Sockalingam S 13 , Katsumata Y 14 , Harigai M 15 , Zhang Z 16 , Chan M 17 , Kikuchi J 18 , Takeuchi T 19 , Bae SC 20 , Goldblatt F 21 , O'Neill S 22 , Ng K 23 , Basnayake BMDB 24 , Tugnet N 25 , Tanaka Y 26 , Lau CS 27 , Li N 28 , Golder V 29 , Hoi A 28 , Kandane-Rathnayake R 28 , Morand E 28 , Oon S 30 , Nikpour M 31

Affiliations 

  • 1 Teaching Hospital Kandy, Kandy, Sri Lanka
  • 2 Peking University First Hospital, Beijing, China
  • 3 Rheumatology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
  • 4 Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
  • 5 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
  • 6 National University Hospital Singapore Pte Ltd, Singapore
  • 7 Department of Medicine, Woodlands Health, Singapore
  • 8 Rheumatology Division, Internal Medicine, Padjadjaran University, Bandung, Indonesia
  • 9 Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
  • 10 Department of Medicine, Division of Allergy, Immunology and Rheumatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
  • 11 University of Santo Tomas Hospital, Manila, Philippines
  • 12 University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
  • 13 Peking University Health Science Center, Beijing, China
  • 14 University of Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
  • 15 Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
  • 16 Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
  • 17 Rheumatology and Clinical Immnunology, Peking University First Hospital, Beijing, China
  • 18 Tan Tock Seng Hospital, Singapore
  • 19 Division of Rheumatology, Keio University School of Medicine Department of Internal Medicine, Shinjuku-ku, Tokyo, Japan
  • 20 Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
  • 21 Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seongdong-gu, Seoul, The Republic of Korea
  • 22 Repatriation General Hospital, Daw Park, South Australia, Australia
  • 23 Liverpool Hospital, Liverpool, New South Wales, Australia
  • 24 North Shore Hospital, Auckland, New Zealand
  • 25 Auckland District Health Board, Auckland, New Zealand
  • 26 First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Fukuoka, Japan
  • 27 The University of Hong Kong, Hong Kong, Hong Kong
  • 28 School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  • 29 Rheumatology, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  • 30 Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
  • 31 The University of Sydney School of Public Health, Sydney, New South Wales, Australia mandana.nikpour@sydney.edu.au
Lupus Sci Med, 2024 Sep 18;11(2).
PMID: 39299757 DOI: 10.1136/lupus-2024-001217

Abstract

OBJECTIVES: The lupus low disease activity state (LLDAS) allows for certain clinical and/or serological activity of SLE, provided overall disease activity does not exceed predefined cut-offs. This study aimed to evaluate the outcomes of patients who achieved LLDAS with clinical activity, serological activity only or neither clinical nor serological activity.

METHODS: Patients with SLE enrolled in a prospective multinational cohort from March 2013 to December 2020 who were in LLDAS at least once were included. Visits that fulfilled both LLDAS and Definition of Remission in SLE (DORIS) criteria were excluded.

RESULTS: 2099 patients were included, with median follow-up of 3.5 (IQR 1.3-5.8) years. At 6150 visits, patients were in LLDAS but not DORIS criteria; of these 1280 (20.8%) had some clinical activity, 3102 (50.4%) visits had serological activity only and 1768 (28.8%) visits had neither clinical nor serological activity. Multivariable regression analysis showed that compared with non-LLDAS, all three subsets of LLDAS had a protective association with flares in the ensuing 6 months and damage accrual in the ensuing 36 months. LLDAS with no clinical or serological activity had a significantly stronger protective association with severe flares in the ensuing 6 months compared with LLDAS with clinical activity (HR 0.47, 95% CI (0.27 to 0.82), p=0.007).

CONCLUSIONS: LLDAS without any clinical activity accounted for almost 80% of LLDAS visits. This study confirms that all subsets of LLDAS are associated with reduced flare and damage accrual. However, LLDAS without any clinical or serological activity has the strongest protective association with severe flares.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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