Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32‐Year Period

Abstract

Objective. Systemic lupus erythematosus (SLE) is characterized by an unpredictable and fluctuating course. Although various methods have been developed to measure disease activity, there is still a lack of consensus about the optimal criteria for SLE remission. The principal aim of our study was to identify the number of lupus patients achieving a complete remission (implying that for 3 years there were no clinical or serologic features and no treatment with steroids and immunosuppressive drugs) in a single cohort of patients followed for a period of up to 32 years. In addition, we have identified patients in clinical but not serologic remission (known as serologically active, clinically quiescent disease [SACQ]) and vice versa. We were particularly interested to determine the factors associated with complete remission. Methods. Eligible patients were followed up in the University College Hospital Lupus cohort from January 1978 until December 2010 for a period of at least 3 years. Complete remission was defined as a period of at least 3 years with clinical inactivity (British Isles Lupus Assessment Group scores of C, D, or E only) and laboratory remission (no antibodies to double-stranded DNA and normal complement C3 levels), and being off-treatment with corticosteroids and immunosuppressants. Antimalarial and nonsteroidal antiinflammatory drugs were allowed. Results. Of 624 lupus patients at our hospital, a total of 532 patients met the strict inclusion criteria for the study. Of these 532 patients, 77 patients (14.5%) achieved complete remission for at least 3 years, and 23 (4.3%) achieved complete remission for a minimum period of 10 years. Ten of these 77 patients were subsequently lost to followup, and, interestingly, flares occurred subsequently in 15 of the 67 remaining patients (22.4%). Three patients relapsed after the tenth year of remission. Forty-five patients (8.5%) fulfilled the requirement for SACQ, and 66 patients (12.4%) achieved only serologic remission. Conclusion. Our study indicated that 14.5% of lupus patients achieved a complete remission for 3 years. However, flares may continue to occur beyond 10 years of remission. Long-term followup of SLE is therefore mandatory.

A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)

“…The task force discussed whether definitions of remission should distinguish patients who are serologically active from those who are serologically inactive, as the former are much more likely to experience subsequent flare 4 9. No consensus was reached on that statement and the task force suggested to test each of the clinical criteria with and without serology, in order to determine the usefulness of the latter and whether it adds to the construct validity of each definition.…”

Prevalence of remission and its effect on damage and quality of life in Chinese patients with systemic lupus erythematosus

“…An Italian study reported that 7.1% of their 224 SLE patients achieved sustained remission for 5 years or more, which was defined as a SLEDAI score of 0 and the absence of immunosuppressive therapy except HCQ 10. More recently, a study from UK defined complete SLE remission as clinical inactivity (British Isles Lupus Assessment Group scores of C, D and E only), absence of laboratory evidence of serological activity (normal complement and negative anti-dsDNA) and being off treatment except the antimalarial drugs 12. Of 532 patients, 14.5% achieved complete remission for ≥3 years and 4.3% did so for ≥10 years.…”

Association of toll‑like receptor 9 expression with prognosis of systemic lupus erythematosus

“…Currently, there are no reliable predictors of SLE prognosis and the majority of studies concerning SLE prognosis have been clinical reports. It has been demonstrated that glomerulonephritis, vasculitis and hematological abnormalities are independent risk factors for the absence of clinical remission in patients with SLE (4) and a recent study, demonstrated that renal and neurological involvement decreased the likelihood of remission and favorable prognosis (35). The results of the current study are partially consistent with those from these previous studies, as it was demonstrated that renal involvement is an independent risk factor and increased levels of TLR9 mRNA and C-reactive protein in the whole blood are risk factors for poor prognosis in patients with SLE.…”