Teaching Hospital Kandy, Kandy, Sri Lanka.
Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Lupus Sci Med. 2024 Sep 18;11(2):e001217. doi: 10.1136/lupus-2024-001217.
The lupus low disease activity state (LLDAS) allows for certain clinical and/or serological activity of SLE, provided overall disease activity does not exceed predefined cut-offs. This study aimed to evaluate the outcomes of patients who achieved LLDAS with clinical activity, serological activity only or neither clinical nor serological activity.
Patients with SLE enrolled in a prospective multinational cohort from March 2013 to December 2020 who were in LLDAS at least once were included. Visits that fulfilled both LLDAS and Definition of Remission in SLE (DORIS) criteria were excluded.
2099 patients were included, with median follow-up of 3.5 (IQR 1.3-5.8) years. At 6150 visits, patients were in LLDAS but not DORIS criteria; of these 1280 (20.8%) had some clinical activity, 3102 (50.4%) visits had serological activity only and 1768 (28.8%) visits had neither clinical nor serological activity. Multivariable regression analysis showed that compared with non-LLDAS, all three subsets of LLDAS had a protective association with flares in the ensuing 6 months and damage accrual in the ensuing 36 months. LLDAS with no clinical or serological activity had a significantly stronger protective association with severe flares in the ensuing 6 months compared with LLDAS with clinical activity (HR 0.47, 95% CI (0.27 to 0.82), p=0.007).
LLDAS without any clinical activity accounted for almost 80% of LLDAS visits. This study confirms that all subsets of LLDAS are associated with reduced flare and damage accrual. However, LLDAS without any clinical or serological activity has the strongest protective association with severe flares.
狼疮低疾病活动状态（LLDAS）允许 SLE 存在一定的临床和/或血清学活动，只要总体疾病活动不超过预先设定的截止值。本研究旨在评估达到 LLDAS 且存在临床活动、仅存在血清学活动或既无临床活动也无血清学活动的患者的结局。
纳入 2013 年 3 月至 2020 年 12 月期间参与前瞻性多国队列研究且至少有一次处于 LLDAS 的 SLE 患者。排除同时符合 LLDAS 和系统性红斑狼疮缓解定义（DORIS）标准的就诊。
共纳入 2099 例患者，中位随访时间为 3.5（IQR 1.3-5.8）年。在 6150 次就诊中，患者处于 LLDAS 但不符合 DORIS 标准；其中 1280 次就诊（20.8%）存在一定的临床活动，3102 次就诊（50.4%）仅存在血清学活动，1768 次就诊（28.8%）既无临床活动也无血清学活动。多变量回归分析显示，与非 LLDAS 相比，所有三种 LLDAS 亚组在接下来的 6 个月内与 flares 和接下来的 36 个月内与损伤累积均具有保护相关性。与有临床活动的 LLDAS 相比，无任何临床或血清学活动的 LLDAS 与接下来的 6 个月内严重 flares 的相关性更强（HR 0.47，95%CI（0.27 至 0.82），p=0.007）。
无任何临床活动的 LLDAS 占 LLDAS 就诊的近 80%。本研究证实，所有 LLDAS 亚组均与 flares 减少和损伤累积减少相关。然而，无任何临床或血清学活动的 LLDAS 与严重 flares 的相关性最强。
