Background Systemic lupus erythematosus (SLE) is characterized by a diversity of disease activity.
Objectives The aim of this study was to identify prognostic factors of persistent disease activity and persistent long quiescence using baseline demographics and clinical characteristics.
Methods Patients enrolled in the Hopkins Lupus Cohort from 1987 to 2014, who had at least 3 visits per year during 3 years following cohort inclusion and available information on disease activity were included. Three major patterns of SLE disease activity over time (1 year intervals) based on the modified SLE Disease Activity Index have been previously described: long quiescent (LQ), chronic active (CA) and relapsing-remitting (RR) (1). Based on maintenance of the aforementioned patterns over 3 consecutive years, patterns have been defined as: Persistent Long Quiescent (pLQ), Persistent Relapsing-Remitting (pRR), Persistent Chronic Active (pCA) and Mixed, at least 2 different pattern types. Predictors of pCA (vs. pLQ, pRR and mixed) and pLQ (vs. pCA, pRR and mixed) were identified by univariate and multivariate logistic regression analyses. Several baseline demographics (age, sex, ethnicity, disease duration, tobacco use, years of education and combined annual family income), disease characteristics at baseline (SLEDAI, PGA) and treatment categories (hydroxychloroquine, prednisolone and cytotoxic treatment followed at ≥75% of visits vs <75% of visits) were used as independent variables.
Results 916 patients were identified. The results of the univariate analyses for pCA are shown in table 1. In the multivariate model, African American ethnicity (OR: 2.43, 95% CI: 1.19–4.94, p: 0.01) and high baseline SLEDAI (OR: 1.09, 95% CI: 1.03–1.16, p: 0.004) remained significant predictors of pCA. Higher education (>12 years; OR. 2.16, 95% CI: 1.11–4.20, p: 0.02) and low baseline SLEDAI (OR: 0.62, 95% CI: 0.52–0.75, p:<0.001) were significant predictors of pLQ in the multivariate analysis while African American ethnicity (OR: 0.36, 95% CI: 0.16–0.78, p:0.01) and female patients (OR: 0.26, 95% CI: 0.12–0.56, p:0.001) were less likely to achieve persistent long quiescence.
Conclusions In this large SLE cohort, African American ethnicity and high disease activity at the time of diagnosis are predictors of chronic activity, regardless of treatment, even after adjustment for education years and income, while higher education and low disease activity at baseline predict long-term quiescence.
Györi N, et al. Disease activity patterns over time in patients with systemic lupus erythematosus – Analysis of the Hopkins Lupus Cohort. Lupus Sci Med. 2017. In press.
Disclosure of Interest None declared