Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort

被引：41

作者：

Francisco Ugarte-Gil, Manuel ^{[1
,2
]}

Hanly, John ^{[3
,4
,5
]}

Urowitz, Murray ^{[6
]}

Gordon, Caroline ^{[7
]}

Bae, Sang-Cheol ^{[8
,9
,10
]}

Romero-Diaz, Juanita ^{[11
]}

Sanchez-Guerrero, Jorge ^{[11
,12
,13
]}

Bernatsky, Sasha ^{[14
,15
]}

Clarke, Ann Elaine ^{[16
]}

Wallace, Daniel J. ^{[17
]}

Isenberg, David Alan ^{[18
]}

Rahman, Anisur ^{[18
]}

Merrill, Joan T. ^{[19
]}

Fortin, Paul R. ^{[20
]}

Gladman, Dafna D. ^{[6
]}

Bruce, Ian N. ^{[21
]}

Petri, Michelle ^{[22
]}

Ginzler, Ellen M. ^{[23
]}

Dooley, Mary Anne ^{[24
]}

Ramsey-Goldman, Rosalind ^{[25
,26
]}

Manzi, Susan ^{[27
]}

Jonsen, Andreas ^{[28
]}

van Vollenhoven, Ronald F. ^{[29
]}

Aranow, Cynthia ^{[30
]}

Mackay, Meggan ^{[30
]}

Ruiz-Irastorza, Guillermo ^{[31
]}

Lim, Sam ^{[32
]}

Inanc, Murat ^{[33
]}

Kalunian, Ken ^{[34
]}

Jacobsen, Soren ^{[35
]}

Peschken, Christine ^{[36
,37
]}

Kamen, Diane L. ^{[38
]}

Askanase, Anca ^{[39
]}

Pons-Estel, Bernardo A. ^{[40
]}

Alarcon, Graciela S. ^{[41
,42
]}

机构：

[1] Univ Cient Sur, Grp Peruano Estudio Enfermedades Autoinmunes Sist, Lima, Peru

[2] Hosp Nacl Guillermo Almenara Irigoyen, EsSalud, Rheumatol, Lima, Peru

[3] Queen Elizabeth 2 Hlth Sci Ctr, Dept Med, Div Rheumatol, Halifax, NS, Canada

[4] Queen Elizabeth 2 Hlth Sci Ctr, Dept Pathol, Halifax, NS, Canada

[5] Dalhousie Univ, Halifax, NS, Canada

[6] Univ Toronto, Toronto Western Hosp, Schroeder Arthrit Inst, Krembil Res Inst, Toronto, ON, Canada

[7] Univ Birmingham, Coll Med & Dent Sci, Inst Inflammat & Ageing, Rheumatol Res Grp, Birmingham, W Midlands, England

[8] Hanyang Univ Hosp Rheumat Dis, Seoul, South Korea

[9] Hanyang Univ, Inst Rheumatol Res, Seoul, South Korea

[10] Hanyang Univ, Inst Biosci & Biotechnol, Seoul, South Korea

[11] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Inmunol & Reumatol, Mexico City, DF, Mexico

[12] Univ Toronto, Sinai Hlth Syst, Toronto, ON, Canada

[13] Univ Toronto, Univ Hlth Network, Div Rheumatol, Toronto, ON, Canada

[14] McGill Univ, Div Rheumatol, Montreal, PQ, Canada

[15] McGill Univ, Div Clin Epidemiol, Montreal, PQ, Canada

[16] Univ Calgary, Cumming Sch Med, Div Rheumatol, Calgary, AB, Canada

[17] Univ Calif Los Angeles, David Geffen Sch Med, Cedars Sinai, Los Angeles, CA 90095 USA

[18] UCL, Med, London, England

[19] Oklahoma Med Res Fdn, Dept Clin Pathol, 825 NE 13th St, Oklahoma City, OK 73104 USA

[20] CHU Quebec Univ Laval, Ctr ARThrite, Rheumatol, Quebec City, PQ, Canada

[21] Univ Manchester, Manchester Acad Hlth Sci Ctr, Fac Biol Med & Hlth, Manchester, Lancs, England

[22] Johns Hopkins Univ, Sch Med, Div Rheumatol, Baltimore, MD USA

[23] Suny Downstate Med Ctr, Dept Med, Brooklyn, NY 11203 USA

[24] Univ N Carolina, Thurston Arthrit Res Ctr, Chapel Hill, NC 27515 USA

[25] Northwestern Univ, Dept Med, Div Rheumatol, Chicago, IL 60611 USA

[26] Feinberg Sch Med, Chicago, IL 60611 USA

[27] Allegheny Hlth Network, Lupus Ctr Excellence, Pittsburgh, PA USA

[28] Lund Univ, Dept Clin Sci Lund, Rheumatol, Lund, Sweden

[29] Amsterdam Univ Med Ctr, Dept Rheumatol, Amsterdam, Netherlands

[30] Feinstein Inst Med Res, Northwell Hlth Manhasset, Manhasset, NY USA

[31] Univ Basque Country, BioCruces Bizkaia Hlth Res Inst, Autoimmune Dis Res Unit, Balakaldo, Spain

[32] Emory Univ, Sch Med, Div Rheumatol, Atlanta, GA USA

[33] Istanbul Univ, Istanbul Med Fac, Dept Internal Med, Div Rheumatol, Istanbul, Turkey

[34] Univ Calif San Diego, Sch Med, La Jolla, CA 92093 USA

[35] Univ Copenhagen, Rigshosp, Copenhagen Res Ctr Autoimmune Connect Tissue Dis, Copenhagen, Denmark

[36] Univ Manitoba, Dept Med, Winnipeg, MB, Canada

[37] Univ Manitoba, Dept Community Hlth Sci, Winnipeg, MB, Canada

[38] Med Univ South Carolina, Div Rheumatol, Charleston, SC 29425 USA

[39] Columbia Univ, Irving Med Ctr, New York, NY USA

[40] Ctr Reg Enfermedades Autoinmunes & Reumat GO CREA, Rosario, Argentina

[41] Univ Alabama Birmingham, Heersink Sch Med, Birmingham, AL USA

[42] Univ Peruana Cayetano Heredia, Fac Med, Lima, Peru

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2022年 / 81卷 / 11期

基金：

新加坡国家研究基金会; 英国惠康基金;

关键词：

systemic lupus erythematosus; outcome assessment; health care; epidemiology; PHYSICIAN GLOBAL ASSESSMENT; ACTIVITY STATE; PROLONGED REMISSION; INITIAL VALIDATION; CAUCASIAN PATIENTS; PREVALENCE; LUMINA; SLE; DEFINITIONS; PREDNISONE;

D O I：

10.1136/ard-2022-222487

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual. Methods Patients with >= 2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K=0, without prednisone or immunosuppressants; remission on-treatment: cSLEDAI-2K score=0, prednisone <= 5 mg/day and/or maintenance immunosuppressants; low disease activity Toronto cohort (LDA-TC): cSLEDAI-2K score of <= 2, without prednisone or immunosuppressants; modified lupus low disease activity (mLLDAS): Systemic Lupus Erythematosus Disease Activity Index-2K score of 4 with no activity in major organ/systems, no new disease activity, prednisone <= 7.5 mg/day and/or maintenance immunosuppressants; active: all remaining visits. Only the most stringent definition was used per visit. Antimalarials were allowed in all. The proportion of time that patients were in a specific state at each visit since cohort entry was determined. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and multivariable generalised estimated equation negative binomial regression models were used. Time-dependent covariates were determined at the same annual visit as the disease activity state but the SDI at the subsequent visit. Results There were 1652 patients, 1464 (88.6%) female, mean age at diagnosis 34.2 (SD 13.4) years and mean follow-up time of 7.7 (SD 4.8) years. Being in remission off-treatment, remission on-treatment, LDA-TC and mLLDAS (per 25% increase) were each associated with a lower probability of damage accrual (remission off-treatment: incidence rate ratio (IRR)=0.75, 95% CI 0.70 to 0.81; remission on-treatment: IRR=0.68, 95% CI 0.62 to 0.75; LDA: IRR=0.79, 95% CI 0.68 to 0.92; and mLLDAS: IRR=0.76, 95% CI 0.65 to 0.89)). Conclusions Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.

引用

页码：1541 / 1548

页数：8

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