High disease activity at baseline does not prevent a remission in patients with systemic lupus erythematosus

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.

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“…Previous studies have used a SLEDAI score to evaluate disease activity (9,12). However, in our study, disease activity was measured by BILAG.…”

Section: Discussionmentioning

confidence: 99%

“…Formiga et al (9) reported that 24 of 100 white patients achieved remission at least for a year and remained in remission for an average time of 55 months. They used the SLEDAI score to assess activity since the onset of disease, and found that higher SLEDAI scores correlated with later remission.…”

Section: Discussionmentioning

confidence: 99%

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

Medina-Quiñones

Ramos-Merino

Ruiz-Sada

et al. 2016

Arthritis Care & Research

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“…Previous studies addressing the issue of remission in SLE reported divergent results 7–9 12 16 18 24. The main reasons for discrepancies among these studies are the use of different definitions of remission.…”

Section: Discussionmentioning

confidence: 99%

Prolonged remission in Caucasian patients with SLE: prevalence and outcomes

et al. 2015

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AIM: \ud \ud To assess the prevalence of prolonged remission in Caucasian patients affected with systemic lupus erythematosus (SLE) and its relationship with damage accrual.\ud \ud METHODS: \ud \ud Caucasian patients diagnosed with SLE between 1990 and 2009 and quarterly seen from 2009 to 2013 were included in the study. We defined remission as prolonged when lasting ≥5 consecutive years. Three levels of remission were defined using the SLE Disease Activity Index-2000 (SLEDAI-2K): complete remission: no disease activity in corticosteroid-free and immunosuppressant-free patients; clinical remission off corticosteroids: serologically active clinical quiescent (SACQ) disease in corticosteroid-free patients and clinical remission on corticosteroids: SACQ disease in patients taking prednisone 1-5 mg/day. Damage was measured by the SLICC/American College of Rheumatology Damage Index (SDI).\ud \ud RESULTS: \ud \ud 224 patients fulfilled inclusion criteria: 196 (87.5%) were women, mean±SD disease duration 11.2±6.8 years. During the 5-year follow-up, 16 patients (7.1%) achieved prolonged complete remission, 33 (14.7%) prolonged clinical remission off corticosteroids and 35 (15.6%) prolonged clinical remission on corticosteroids. At the multivariate analysis, vasculitis (OR 4.95), glomerulonephritis (OR 2.38) and haematological manifestations (OR 2.19) over the patients' disease course were associated with an unremitted disease. SDI increased more frequently in unremitted (72/140, 51.4%) than in remitted patients (22/84, 26.2%; p=0.001); SDI median increase was higher in unremitted than in remitted patients: 1 (0-3) vs 0 (0-2), respectively (p<0.001). At multivariate analysis, unremitted disease (OR 2.52) and high-dose corticosteroid intake (OR 2.35) were risk factors for damage accrual.\ud \ud CONCLUSIONS: \ud \ud Thirty-seven percent of our Caucasian patients achieved a prolonged remission, which was associated with a better outcome in terms of damage accrual

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“…Other common minimal durations are 1 and 2 years. Different studies have shown quite consistent results for the 1 year remission rates, with ranges between 18.9% and 28.4% if serological activity was allowed 1 2 12 13 15. In one study where serological activity was not allowed, the 1 year remission rate was just 6.5% 12.…”

Section: Introductionmentioning

confidence: 88%

Remission in systemic lupus erythematosus: durable remission is rare

2016

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High disease activity at baseline does not prevent a remission in patients with systemic lupus erythematosus

Abstract: SLE patients with severe initial clinical manifestations and higher SLEDAI values may achieve clinical remission.

Cited by 26 publications

References 14 publications

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

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

Prolonged remission in Caucasian patients with SLE: prevalence and outcomes

Remission in systemic lupus erythematosus: durable remission is rare

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