Background A majority of systemic lupus erythematosus (SLE) patients have had a relapsing-remitting clinical course.
Objectives To determine the clinically quiescent survival time and the associated factors of prolong clinically quiescent phase in newly diagnosed SLE patients
Methods SLE patients in an inception lupus cohort of newly diagnosed SLE patients who were observed for longer than 1 year and seen between May, 2007 and June, 2012 at Rheumatology clinic, Chiang Mai University were included. All patients were assessed for clinically quiescence, modified-SLE disease activity index 2000 (mSLEDAI-2K) was zero with no increase in treatment, no new features of lupus activity compared to the previous assessment. Once they reached the clinically quiescence, they were assessed for the occurrence of flare, mSLEDAI-2K increase more than three (≥4) when compared to the previous visit, increased disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements, or consideration of a change or an increase in treatment.
Results Ninety-five patients (88 females) with mean ± SD age and disease duration at the study entry were 33.22±13.24 years and 2.79±3.19 months were enrolled during the mean observing periods of 3.04±1.38 years. The initial mSLEDAI-2K score was 13.33±5.57. The SLICC damage index was zero in 70 of 95 (73.68%) patients. Eighty-eight patients (92.63%) reached clinically quiescence. Estimated time from cohort entry to reaching clinically quiescence was 11.31±1.10 months. Forty-five (51.14%) patients had a disease flare. The estimated time from reached clinically quiescent criteria to the first flare of disease (the clinically quiescent phase) was 28.30±3.07 months. In uni-variable analysis, age at SLE diagnosis ≥30 years married patients, non-alopecia at presentation, continuing anti-malarial drug therapy after reached clinically quiescent criteria, had longer clinically quiescent phase. Cox-regression analysis revealed age at diagnosis of ≥30 years (Hazard ratio [HR] 2.26, 95% CI 1.06, 4.82), non-alopecia (HR 2.41, 95% CI 1.18, 4.96) and continuing anti-malarial
Conclusions SLE patients with early diagnosis had a good prognosis. Patients who had age at diagnosis older than 30 years and stay on anti-malarial drug after reaching clinically quiescence may have longer clinically quiescent phase. The confirmed studies are needed.
Disclosure of Interest : None declared
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