Objectives To study the effect of disease remission on organ damage and quality of life in Chinese patients with systemic lupus erythematosus (SLE).
Methods Patients who fulfilled the ACR classification for SLE were studied. Their remission status at last visit was determined by the European consensus (DORIS definition): (1) Complete remission (clinical SLEDAI=0, serology inactive); and (2) Clinical remission (clinical SLEDAI=0, serology active). These two categories were further divided into those who required ongoing immunosuppressive treatment (prednisone ≤5mg/d or other immunosuppressive agents) and who did not. The increase in SLE organ damage (SDI) score since 5 years prior to recruitment was compared between patients who were and were not in remission for ≥5 years. Participants were randomly selected for assessment of quality of life by using both the validated version of SF36 and the LupusPRO (version 1.8) and comparison was made between those who did and did not achieve remission for ≥5 years by the independent Students' t-test.
Results 769 SLE patients were studied (92% women; age 46.4±14.6 years, SLE duration 12.6±8.1 years). At last visit, clinical remission was present in 259 (33.7%) patients (median 43 months) and complete remission (clinically and serologically inactive) was present in 280 (36.4%) patients (median 51 months). Clinical/complete remission for ≥5years was achieved in 64 (8.3%) and 129 (16.8%) of the patients, respectively. 53 (6.9%) patients in remission ≥5 years were taken off all medications including HCQ (drug-free). Compared with patients who did not remit, those remitted ≥5 years were older (49.9±13.2 vs 45.7±15.8; p=0.004), and had significantly lower prevalence of renal involvement, leukopenia or thrombocytopenia. Significantly fewer patients who remitted for ≥5 years were maintained on prednisolone compared to others (31% vs 68%; p<0.001). The increase in SDI scores over the preceding 5 years was 0.17±0.53 in patients who had complete/clinical remission off-therapy (except HCQ) for ≥5 years (N=88), 0.25±0.51 in those remitted for ≥5 years but maintained on immunosuppressive medications (N=105), 0.41±0.84 in those remitted for <5 years (N=346) and 0.67±1.10 in those who did not remit (N=230), respectively. The increase in SDI was statistically higher in those remitted for ≥5 years than <5 years (p=0.007) or those who did not remit (p<0.001). Logistic regression showed that patients with remission for <5 years or who did not remit had an increase in the risk of new damage accrual as compared to those with remission for ≥5 years (OR 2.42 [1.50–3.89]; p<0.001), adjusted for age, sex, SLE duration, SDI scores 5 years prior and the daily maintenance prednisolone dose at last visit. Among 453 patients who had QOL assessment, remission for ≥5 years was associated with significantly higher higher physical component and mental component scores of the SF36 than those who did not remit. Patients with remission for ≥5 years had significantly higher scores in the individual health-related domains (except cognition) of the LupusPRO than those who did not remit.
Conclusions Durable remission can be achieved in a quarter of patients with SLE. Patients with remission for ≥5 years have significantly less damage accrual and better QOL. Prolonged remission is an appropriate parameter for outcome assessment in SLE.
Disclosure of Interest None declared