Both prolonged remission and Lupus Low Disease Activity State are associated with reduced damage accrual in systemic lupus erythematosus

Abstract

This cohort study shows that prolonged remission and LLDAS were associated with an improved outcome, as determined by yearly assessments. In order to improve the outcome in SLE patients, future studies should investigate whether these targets can be reached actively with therapeutic strategies.

Lupus low disease activity state is associated with a decrease in damage progression in Caucasian patients with SLE, but overlaps with remission

“…We demonstrated that prolonged remission, defined as 5 or more consecutive years of no clinical disease activity (SLEDAI-2K=0) in patients treated with antimalarials and/or stable dose of immunosuppressive drugs and/or prednisone ≤5 mg/day, was associated with a decrease in damage progression 10. This finding was confirmed by Tsang-A-Sjoe et al in a multiethnic cohort in the Netherlands 15. In a further study,11 we found that a remission lasting at least 2 years had still a protective effect against new damage.…”

“…In fact, the definition of LLDAS used in the study by Franklyn et al 12 Tsang-A-Sjoe et al 15 as well as in our study included patients who were in LDA but also patients in true remission. This is different from what was defined for RA and other rheumatic diseases,21 22 where the definitions of LDA and remission do not overlap (eg, disease activity score (DAS)-28 in RA identifies remitted patients when DAS-28 is lower than 2.6, while patients in LDA have a DAS-28 between 2.6 and 3.2).…”

Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL)

“…In an Italian cohort, 7.1% of the patients achieved remission for at least 5 years11 whereas 12.8% did so in a Netherlands’ cohort12; 24% achieved remission for at least 1 year in a Spaniard cohort. Including PGA in the definition, 5.4% of LCTC patients were on remission for at least 1 year 5…”

Clinical Remission and Low Disease Activity Outcomes Over 10 Years in Systemic Lupus Erythematosus

“…Using this definition, a SLEDAI-2K score ≤4 is permitted (without any activity from the major organ systems), thus allowing for arthritis and myositis to be present. Likewise, a study by Tsang-A-Sjoe et al showed that LLDAS observed in ≥50% of observations (1 annual visit) was characterized by a 48% reduced risk of damage accrual as compared to patients with <50% time in LLDAS after 5 years (19). As such, it is questionable wheather a shortlived, partial remission (similar to the LLDAS) is clinically meaningful.…”