Polachek Ari, Gladman Dafna D, Su Jiandong, Urowitz Murray B
University of Toronto, Center for Prognostic Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
University of Toronto, Krembil Research Institute, and Center for Prognostic Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2017 Jul;69(7):997-1003. doi: 10.1002/acr.23109.
To define and identify a group of systemic lupus erythematosus patients with low disease activity (LDA) and to examine whether LDA is similar to patients in remission and different from a high disease activity group (HDA) in short-term outcomes.
The LDA group was defined as Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) <3, including only 1 clinical manifestation of rash, alopecia, mucosal ulcers, pleurisy, pericarditis, fever, thrombocytopenia, or leukopenia. The patients could be taking antimalarials. Remission was defined as no clinical manifestation from taking antimalarials alone, and the HDA group was defined as SLEDAI-2K >6. The time frame for inclusion in each group was at least 1 year.
Of 620 patients with active disease who were seen between 1970 and 2015, 80 patients (12.9%) fulfilled the criteria for LDA, 191 (30.8%) for remission, and 349 (56.3%) for HDA. The LDA patients with and without positive serology results were similar at baseline and with prior disease characteristics. After 2 years of followup, the LDA and remission groups were similar in their adjusted mean SLEDAI-2K score, organ involvement, The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score, mortality, and therapies. After 2 and 4 years of followup, the HDA group had a higher adjusted mean SLEDAI-2K score, more major organ involvement, a higher SDI score, higher mortality, and more therapy compared to the combined LDA/remission groups.
LDA and remission groups had similar short-term outcomes, and both had better outcomes and prognosis than the HDA group. LDA may be used as an outcome measure in therapeutic trials or in treat-to-target regimens.
定义并识别一组疾病活动度低（LDA）的系统性红斑狼疮患者，并研究LDA患者在短期预后方面是否与病情缓解的患者相似，以及与高疾病活动度组（HDA）是否不同。
LDA组定义为系统性红斑狼疮疾病活动指数2000（SLEDAI-2K）<3，仅包括皮疹、脱发、黏膜溃疡、胸膜炎、心包炎、发热、血小板减少或白细胞减少中的1种临床表现。患者可以正在服用抗疟药。病情缓解定义为仅服用抗疟药时无临床表现，HDA组定义为SLEDAI-2K>6。每组纳入的时间范围至少为1年。
在1970年至2015年间就诊的620例活动性疾病患者中，80例（12.9%）符合LDA标准，191例（30.8%）病情缓解，349例（56.3%）为HDA。血清学结果阳性和阴性的LDA患者在基线和既往疾病特征方面相似。随访2年后，LDA组和病情缓解组在调整后的平均SLEDAI-2K评分、器官受累情况、系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数（SDI）评分、死亡率和治疗方法方面相似。随访2年和4年后，与LDA/病情缓解合并组相比，HDA组的调整后平均SLEDAI-2K评分更高，主要器官受累更多，SDI评分更高，死亡率更高，治疗更多。
LDA组和病情缓解组的短期预后相似，且两者的预后均优于HDA组。LDA可作为治疗试验或达标治疗方案中的一项预后指标。
