Flare, Persistently Active Disease, and Serologically Active Clinically Quiescent Disease in Systemic Lupus Erythematosus: A 2-Year Follow-Up Study

Abstract

ObjectiveSeveral indices have been proposed to assess disease activity in patients with Systemic Lupus Erythematosus (SLE). Recent studies have showed a prevalence of flare between 28–35.3%, persistently active disease (PAD) between 46%–52% and serologically active clinically quiescent (SACQ) disease ranging from 6 to 15%. Our goal was to evaluate the flare, PAD and SACQ rate incidence in a cohort of SLE patients over a 2-year follow-up.MethodsWe evaluated 394 SLE patients. Flare was defined as an increase in SLEDAI-2K score of ≥4 from the previous visit; PAD was defined as a SLEDAI-2K score of ≥4, on >2 consecutive visits; SACQ was defined as at least a 2-year period without clinical activity and with persistent serologic activity.ResultsAmong the 95 patients eligible for the analysis in 2009, 7 (7.3%) had ≥1 flare episode, whereas 9 (9.4%) had PAD. Similarly, among the 118 patients selected for the analysis in 2010, 6 (5%) had ≥1 flare episode, whereas 16 (13.5%) had PAD. Only 1/45 patient (2.2%) showed SACQ during the follow-up.ConclusionWe showed a low incidence of flare, PAD and SACQ in Italian SLE patients compared with previous studies which could be partly explained by ethnic differences.

Assessment of disease activity in Systemic Lupus Erythematosus: Lights and shadows

“…Notably, the great majority of SLE patients experiencing flares were not under immunosuppressants. Moreover, these patients showed a significantly longer disease duration compared with those who did not experience flares in both years of observation [61]. The lower incidence of flare compared with data from Nikpour et al was explained by the different ethnicity in the two cohorts, i.e., the presence of one-third of African-American patients in the Canadian cohort [60,61].…”

“…The evaluation of flare according with this definition identified a lower frequency in the paper by Conti et al [61]. The study published in 2012 demonstrated an incidence of 7.3% of flare in the first year, and 5% in the second year of follow-up.…”

Mycophenolate mofetil in systemic lupus erythematosus: results from a retrospective study in a large monocentric cohort and review of the literature

“…Disease activity was measured according to the SLE Disease Activity Index 2000 (SLEDAI-2K). Persistently, active disease (PAD) was defined as a SLEDAI-2K score C4, excluding serology alone, on C2 consecutive visits, with a minimum interval of 2 months between visits [12,30]. Flare was defined as an increase in SLEDAI-2K score of C4 from the previous visit [12].…”

“…Persistently, active disease (PAD) was defined as a SLEDAI-2K score C4, excluding serology alone, on C2 consecutive visits, with a minimum interval of 2 months between visits [12,30]. Flare was defined as an increase in SLEDAI-2K score of C4 from the previous visit [12]. The renal SLEDAI, which consists of the four kidney-related parameters of the SLEDAI-2K (hematuria, pyuria, proteinuria and urinary casts), was recorded [31].…”

“…A wide range of autoantibodies and clinical manifestations, with a remitting/ relapsing course [3][4][5][6][7][8][9][10][11], characterizes the disease. Treatment modifications are required to control disease activity and to prevent chronic damage [11][12][13][14][15].…”