Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistemicas, Universidad Cientifica del Sur, Lima, Peru
Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
Ann Rheum Dis. 2022 Nov;81(11):1541-1548. doi: 10.1136/ard-2022-222487. Epub 2022 Aug 9.
To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual.
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.
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)).
Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.
确定不同缓解和低疾病活动度（LDA）定义对累积损伤的独立影响。
研究了来自一个纵向多国发病狼疮队列的至少有 2 次年度评估的患者。定义了 5 种互斥的疾病活动状态：停药缓解：临床系统性红斑狼疮疾病活动指数（cSLEDAI）-2K=0，无泼尼松或免疫抑制剂；治疗缓解：cSLEDAI-2K 评分=0，泼尼松≤5mg/天和/或维持性免疫抑制剂；多伦多低疾病活动度队列（LDA-TC）：cSLEDAI-2K 评分≤2，无泼尼松或免疫抑制剂；改良狼疮低疾病活动度（mLLDAS）：系统性红斑狼疮疾病活动指数-2K 评分 4，无主要器官/系统活动，无新的疾病活动，泼尼松≤7.5mg/天和/或维持性免疫抑制剂；活动：所有其余就诊。每次就诊仅使用最严格的定义。允许使用抗疟药。确定患者在每个就诊时处于特定状态的时间比例。使用系统性红斑狼疮国际协作诊所/美国风湿病学会损伤指数（SDI）确定损伤累积。使用单变量和多变量广义估计方程负二项回归模型。时间依赖性协变量在与疾病活动状态相同的年度就诊时确定，但 SDI 在随后的就诊时确定。
共有 1652 名患者，1464 名（88.6%）为女性，诊断时的平均年龄为 34.2（SD 13.4）岁，平均随访时间为 7.7（SD 4.8）年。达到停药缓解、治疗缓解、LDA-TC 和 mLLDAS（每增加 25%）与较低的损伤累积概率相关（停药缓解：发病率比（IRR）=0.75，95%CI 0.70 至 0.81；治疗缓解：IRR=0.68，95%CI 0.62 至 0.75；LDA：IRR=0.79，95%CI 0.68 至 0.92；mLLDAS：IRR=0.76，95%CI 0.65 至 0.89））。
即使调整了可能的混杂因素和效应修饰剂，治疗缓解和停药缓解、LDA-TC 和 mLLDAS 与损伤累积减少相关。
