Evaluation of Lupus Low Disease Activity: Characteristics, Predictors, and Association with Disease Damage: A Retrospective Cohort from Two Tertiary Centers in Egypt
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- Category: Vol. 88, June 2020
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Evaluation of Lupus Low Disease Activity: Characteristics, Predictors, and Association with Disease Damage: A Retrospective Cohort from Two Tertiary Centers in Egypt, BASMA M. MEDHAT, MERVAT E. BEHIRY and NAGLAA AFIFI
Abstract
Background: Remission in systemic lupus erythematosus (SLE) is seldom achieved; making Lupus Low Disease Activity (LLDA) an alternative yet promising target. Aim of Study: The aim of this study was to evaluate the prevalence of remission and LLDA achieved, and the charac-teristics and predictors of LLDA, and its potential association with disease damage. Patients and Methods: The medical records of 243 patients fulfilling the 2012 Systemic Lupus Collaborating Clinics (SLICC) classification criteria for SLE and managed at Cairo and Ainshams Universities from January to December 2019 were viewed. Remission was categorized to: (i) Complete remission off glucocorticoid (GC) and Systemic Lupus Ery-thematosus Disease Activity Index-2K (SLEDAI-2K) = zero (antimalarial only); (ii) Clinical remission off GC with sero-logic activity (SKLEDAI-2K £4); (iii) Clinical remission on GC £5mg/day (SLEDAI-2K score £ 4 and serologic activity). LLDA was defined as SLEDAI-2K £4 in the absence of major organ involvement, GC dosage £7.5mg/day. Disease damage was assessed through the Systemic Lupus International Col-laborating Clinics/American College of Rheumatology Damage Index (SDI). Results: Seventy two (29.6%) patients achieved LLDA at the last visit; whereas 142 (58.4%) patients had a SLEDAI-2K score >4 and/or received a GC dosage of >7.5mg. One (0.4%) and 28 (11.5%) patients achieved clinical remission off and on GC, respectively. None of the patients achieved complete clinical and serologic complete remission. Patients achieving LLDA had an older age of onset compared to those with higher disease activity (p=0.003), and a lower prevalence of fever (p=0.009), weight loss (p=0.07), cutaneous vasculitis (p=0.002), serositis (p=0.006), nephritis (p=0.02), a lower median SDI score, and lower prevalence of developing severe damage (SDI ³3) (p=0.04). Predictors of LLDA were an older age of onset [p=0.006 (OR=1.05; 95% CI=1.01-1.09)] and weight loss [p=0.009 (OR=5; 95% CI=1.9-16.5)]; whereas patients with LLDA were less likely to have cutaneous vas-culitis [p=0.01 (OR=0.2; 95% CI=0.06-0.7)] or pleurisy and/or pleural effusion [p=0.001 (OR=0.2; 95% CI=0.1-0.5)].
Conclusion: Achieving remission was substantially low. Lupus Low Disease Activity (29.6%) was associated with a higher age of onset, several distinct clinical characteristics, and lower damage.