Tani Chiara, Vagelli Roberta, Stagnaro Chiara, Carli Linda, Mosca Marta
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Lupus Sci Med. 2018 Feb 27;5(1):e000234. doi: 10.1136/lupus-2017-000234. eCollection 2018.
To evaluate what proportion of patients fulfil the DORIS definition of remission, the definition of lupus low disease activity state (LLDAS) and LLDAS with a glucocorticoid (GC) dosage ≤5 (LLDAS5) in a longitudinal monocentric cohort of patients with SLE; to identify predictors of sustained remission and LLDAS attainment; to evaluate the effect of sustained remission and LLDAS on damage accrual over a period of 5 years and compare the two conditions in terms of clinical outcomes.
Retrospective analysis of data prospectively collected from patients with SLE followed from 2012 to 2016.
115 patients were included in this analysis. At baseline, 72% of patients were on LLDAS and almost all patients also fulfilled the LLDAS5 definition; 45% of patients were in remission on treatment, 12% were in remission off treatment, 26% were in complete remission on treatment, 2% were in complete remission off treatment. Disease activity at baseline was the strongest predictor of subsequent LLDAS and remission; the presence of joint and cutaneous manifestations was associated with a minor likelihood to achieve LLDAS or remission during follow-up.Patients in remission and LLDAS for the whole follow-up period accrued significantly less organ damage; on the contrary, patients who maintained all kinds of remissions or LLDAS for less than 50% of the time did not show any differences in damage accrual with respect to the rest of the cohort.
Remission and LLDAS, even with reduced GC use, are an achievable goal in clinical practice; sustained LLDAS and remission are both associated with reduced damage accrual.
在一个SLE患者的纵向单中心队列中，评估达到DORIS缓解定义、狼疮低疾病活动状态（LLDAS）定义以及糖皮质激素（GC）剂量≤5的LLDAS（LLDAS5）的患者比例；确定持续缓解和达到LLDAS的预测因素；评估持续缓解和LLDAS对5年内损伤累积的影响，并比较这两种情况在临床结局方面的差异。
对2012年至2016年随访的SLE患者前瞻性收集的数据进行回顾性分析。
本分析纳入了115例患者。基线时，72%的患者处于LLDAS，几乎所有患者也符合LLDAS5定义；45%的患者在治疗中缓解，12%的患者在治疗外缓解，26%的患者在治疗中完全缓解，2%的患者在治疗外完全缓解。基线疾病活动是随后达到LLDAS和缓解的最强预测因素；关节和皮肤表现的存在与随访期间达到LLDAS或缓解的可能性较小相关。在整个随访期间处于缓解和LLDAS的患者累积的器官损伤明显较少；相反，维持各种缓解或LLDAS时间少于50%的患者在损伤累积方面与队列中的其他患者没有差异。
缓解和LLDAS，即使在减少GC使用的情况下，在临床实践中也是可以实现的目标；持续的LLDAS和缓解均与减少损伤累积相关。
