Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Videncenter for Reumatologi og Rygsygdomme, Rigshospitalet Glostrup, Glostrup, Denmark.
Ann Rheum Dis. 2017 Mar;76(3):547-553. doi: 10.1136/annrheumdis-2016-209489. Epub 2016 Aug 24.
Remission is the ultimate goal in systemic lupus erythematosus (SLE). In this study, we applied four definitions of remission agreed on by an international collaboration (Definitions of Remission in SLE, DORIS) to a large clinical cohort to estimate rates and predictors of remission.
We applied the DORIS definitions of Clinical Remission, Complete Remission (requiring negative serologies), Clinical Remission on treatment (ROT) and Complete ROT. 2307 patients entered the cohort from 1987 to 2014 and were seen at least quarterly. Patients not in remission at cohort entry were followed prospectively. We used the Kaplan-Meier approach to estimate the time to remission and the time from remission to relapse. Cox regression was used to identify baseline factors associated with time to remission, adjusting for baseline disease activity and baseline treatment.
The median time to remission was 8.7, 11.0, 1.8 and 3.1 years for Clinical Remission, Complete Remission, Clinical ROT and Complete ROT, respectively. High baseline treatment was the major predictor of a longer time to remission, followed by high baseline activity. The median duration of remission for all definitions was 3 months. African-American ethnicity, baseline low C3 and baseline haematological activity were associated with longer time to remission for all definitions. Baseline anti-dsDNA and baseline low C4 were associated with longer time to Complete Remission and Complete ROT. Baseline low C4 was also negatively associated with Clinical Remission.
Our results provide further insights into the frequency and duration of remission in SLE and call attention to the major role of baseline activity and baseline treatment in predicting remission.
缓解是系统性红斑狼疮（SLE）的最终目标。在这项研究中，我们应用了国际合作（SLE 缓解定义，DORIS）达成的四种缓解定义，对一个大型临床队列进行评估，以估计缓解的发生率和预测因素。
我们应用 DORIS 的临床缓解、完全缓解（需要阴性血清学）、缓解治疗（ROT）和完全 ROT 的定义。1987 年至 2014 年期间，2307 例患者进入队列，每季度至少随访一次。队列进入时未缓解的患者进行前瞻性随访。我们使用 Kaplan-Meier 方法估计缓解时间和缓解至复发的时间。Cox 回归用于识别与缓解时间相关的基线因素，同时调整基线疾病活动和基线治疗。
临床缓解、完全缓解、缓解治疗和完全 ROT 的中位缓解时间分别为 8.7、11.0、1.8 和 3.1 年。基线高治疗是缓解时间延长的主要预测因素，其次是基线高活动。所有定义的缓解中位持续时间为 3 个月。非裔美国人种族、基线低 C3 和基线血液学活动与所有定义的缓解时间延长有关。基线抗 dsDNA 和基线低 C4 与完全缓解和完全 ROT 的缓解时间延长有关。基线低 C4 也与临床缓解时间延长呈负相关。
我们的结果进一步深入了解了 SLE 缓解的频率和持续时间，并提醒人们注意基线活动和基线治疗在预测缓解方面的重要作用。
