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We agree that the lupus low disease activity state (LLDAS) is associated with less long-term damage. We are convinced that true remission should be our ultimate treatment goal. For example, LLDAS allows up to 7.5 mg of prednisone daily, while it was shown that prednisone doses above 6 mg/day significantly increase the risk of later organ damage by 50%.3
Very few patients reach durable remission, regardless of defining remission on treatment or off treatment. Remission is a high bar to aim for with our current treatment strategies.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.