Treat-to-target Endpoint Definitions in Systemic Lupus Erythematosus: More Is Less?

Morand, Eric Francis; Golder, Vera

doi:10.3899/jrheum.190223

Cited by 5 publications

(1 citation statement)

References 23 publications

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“…The main targets of systemic lupus erythematosus (SLE) management are considered to be as follows: attainment of disease remission or the lowest possible level of disease activity, prevention of disease flares and prevention of organ damage [ 1 ]. Indeed, remission and a low disease activity state (LLDAS) are linked to better outcomes in terms of organ damage preservation [ 2 ], fewer incidences of hospitalisation, improved mortality and better quality of life [ 3 , 4 ]. Recent studies have demonstrated an association between remission or LLDAS achievement and better health-related quality of life (HRQoL) in SLE patients, although this may sometimes prove to be a weak association [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Articular involvement, steroid treatment and fibromyalgia are the main determinants of patient-physician discordance in systemic lupus erythematosus

et al. 2020

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Background Remission or the lowest possible disease activity is the main target in the management of systemic lupus erythematosus (SLE). Anyway, conflicting data are present in the literature regarding the correlation between physician-driven definitions and patient perception of the disease. The objective of this study is to evaluate the relationship between the definition of lupus low disease activity state (LLDAS) and patient’s health-related quality of life (HRQoL). Methods This is a cross-sectional, monocentric study. Adult SLE patients were included. For each patient, demographics, disease duration, medications, comorbidities, organ damage, active disease manifestations and SELENA-SLEDAI were assessed. Patients have been categorised as follows: LLDAS, remission and active disease. Each patient completed the following patient-reported outcomes (PROs): SF-36, LIT, FACIT-Fatigue and SLAQ. A SLAQ score < 6 (25° percentile of our cohort) was used as the cut-off value to define a low disease activity state according to patient self-evaluation. Results We enrolled 259 consecutive SLE patients (mainly female and Caucasian, mean age 45.33 ± 13.14 years, median disease duration 14 years). 80.3% were in LLDAS, of whom 82.2% were in remission; 19.7% were active. No differences emerged for any of the PROs used between the LLDAS and the active group. Considering the LLDAS subgroup, we identified 56 patients with a subjective low disease activity (SLAQ < 6) and we defined them as “concordant”; the remaining 152 patients in LLDAS presented a subjective active disease (SLAQ ≥ 6) and were defined “discordant”. Discordant patients presented more frequently ongoing and past joint involvement (p < 0.05) and a diagnosis of fibromyalgia (p < 0.01); furthermore, they were more likely to be on glucocorticoid therapy (p < 0.01). Discordant patients showed a significantly poorer HRQoL, assessed by all PROs (p < 0.0001). Conclusions Joint involvement, glucocorticoid therapy and comorbid fibromyalgia resulted to be the most important variables determining the poor concordance between patient and physician perspective on the disease.

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