Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE- CIBIOR, Mexican Institute for Social Security, Puebla, Mexico.
Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
Lupus. 2023 Oct;32(11):1328-1334. doi: 10.1177/09612033231202878. Epub 2023 Sep 13.
Low disease activity state (LDAS) has been linked to a significant reduction in flares and damage accrual in patients with systemic lupus erythematosus (SLE); however, the effect of LDAS on the risk of vertebral fractures (VFs) in subjects with SLE is unknown, considering that low bone mineral density (BMD) and VF are frequent in SLE.
to evaluate whether achieving LDAS ≥50% of the observation time prevents new VF and BMD changes in Mestizo women.
We carried out a longitudinal, observational, and retrospective study. Mestizo women with SLE were included for a median of an 8-year follow-up. LDAS was described as Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score ≤4, prednisone ≤7.5 mg/day, and stable immunosuppressive therapies. BMD measurements and lateral thoracic and lumbar radiographs for a semiquantitative analysis for VF were assessed at baseline and during the follow-up. Uni- and multivariable interval-censored survival regression models were carried out.
We included 110 patients: 35 (31.8%) had new VF. A total of 56 patients (50.1%) achieved LDAS ≥50% of the time during the follow-up and achieved a significantly lesser risk of incident VF (HR = 0.16; 95% CI, 0.06-0.49). After adjusting by age, BMI, menopause, prevalent VF, baseline BMD, cumulative glucocorticoid use, and anti-osteoporotic therapy, LDAS-50 was significantly related to a decrease in the risk of a new VF (HR = 0.39; 95% CI, 0.16-0.98). There was no association between LDAS and BMD measurement changes. When only patients on LDAS but not in remission ( = 43) were evaluated for the risk of incident VF, both uni- and multivariate analyses were significant (HR = 0.12; 95 CI, 0.04-47; = 0.001, and HR = 0.26; 95% CI, 0.7-0.88; = 0.03).
LDAS ≥50% of the time was significantly associated with a diminished risk of new VF in Mestizo women with SLE, even in patients not in remission. However, LDAS did not help modify BMD changes over time.
低疾病活动状态（LDAS）与系统性红斑狼疮（SLE）患者的发作和损伤累积显著减少有关；然而，考虑到低骨密度（BMD）和椎体骨折（VF）在 SLE 中很常见，LDAS 对 SLE 患者 VF 风险的影响尚不清楚。
评估在梅斯蒂索女性中，达到观察时间 50%以上的 LDAS 是否可预防新的 VF 和 BMD 变化。
我们进行了一项纵向、观察性和回顾性研究。纳入了中位随访 8 年的 SLE 梅斯蒂索女性。LDAS 描述为系统性红斑狼疮疾病活动指数 2000（SLEDAI-2K）评分≤4、泼尼松≤7.5mg/天和稳定的免疫抑制治疗。在基线和随访期间评估了骨密度测量值以及用于 VF 半定量分析的胸椎和腰椎侧位片。进行了单变量和多变量间隔 censored 生存回归模型分析。
共纳入 110 例患者：35 例（31.8%）发生新的 VF。在整个随访期间，共有 56 例（50.1%）患者达到 LDAS 时间≥50%，新发 VF 的风险显著降低（HR=0.16；95%CI，0.06-0.49）。在调整年龄、BMI、绝经、基线时存在 VF、BMD、累积糖皮质激素使用和抗骨质疏松治疗后，LDAS-50 与新发 VF 风险降低显著相关（HR=0.39；95%CI，0.16-0.98）。LDAS 与 BMD 测量值的变化无关。当仅评估 LDAS 但未处于缓解期的患者（n=43）发生 VF 的风险时，单变量和多变量分析均有意义（HR=0.12；95%CI，0.04-47；P=0.001，HR=0.26；95%CI，0.7-0.88；P=0.03）。
LDAS 时间≥50%与 SLE 梅斯蒂索女性新发 VF 的风险降低显著相关，即使在未缓解的患者中也是如此。然而，LDAS 并不能帮助改变随时间推移的 BMD 变化。
