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We read the report by Zen et al1 on the impact of lupus low disease activity state (LLDAS) on damage accrual with great interest and would like to congratulate the authors on their work. In this single-centre Caucasian cohort, followed for 7 years, only 38 of their 293 patients (11.3%) failed to achieve LLDAS for at least 1 year; moreover, of the 255 patients who achieved LLDAS for at least 1 year, 246 (96.5%) also satisfied the definition of remission for the same length of time. And, in 214 (83.9%) patients, the duration of remission was the same as that of LLDAS. Being in LLDAS for at least 2 years was associated with a reduced risk of damage; …
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