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Remission in SLE: closing in on the target
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  1. Ronald F van Vollenhoven1,
  2. Alexandre Voskuyl2,
  3. Eric Morand3,
  4. Cynthia Aranow4
  1. 1Department of Medicine, The Karolinska Institute, Stockholm, Sweden
  2. 2Department of Rheumatology, Amsterdam Rheumatology and Immunology Center ARC, Amsterdam, The Netherlands
  3. 3School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  4. 4Center for Autoimmune and Musculoskeletal, The Feinstein Institute for Medical Research, Manhasset, New York, USA
  1. Correspondence to Dr Ronald F van Vollenhoven, Department of Medicine, The Karolinska Institute, ClinTRID, The Karolinska University Hospital D1:0, Stockholm 17176, Sweden; ronald.van.vollenhoven{at}ki.se

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I'm in complete remission. I'm alive and well.Gene Wilder

Over the past decades, the concept of ‘remission’ has emerged as a moniker for the disease state one would ideally like to achieve when a ‘cure’—the ultimate goal of medical intervention—cannot realistically be hoped for. Originally used in oncology to describe the absence of detectable tumour, remission has become an important concept among medical specialties treating autoimmune inflammatory diseases. In some of these disease areas, three distinct processes have taken place:

  • The term remission was introduced into the parlance of the specialty area, so that physicians, researchers and patients would use the term to describe the state they wished to achieve.

  • Remission was specifically defined for each disease; for example, in rheumatoid arthritis (RA) a preliminary American College of Rheumatology (ACR) definition was published in 1981,1 followed by a definition based on the disease activity score or other disease activity indices, and finally by a joint ACR and European League Against Rheumatism (EULAR) definition2; similar developments took place in other chronic inflammatory disease areas, such as inflammatory bowel disease.3

  • Remission was codified as the explicit target of therapeutic interventions, again most notably in RA where ACR4 and EULAR5 guidance as well as the ‘treat-to-target’ work force6 have expressed remission as the goal of therapy for most patients.

Needless to say, these three developments have strongly influenced each other. Thus, the existence of specific and quantitative definitions of remission made it possible to articulate it as a therapeutic target, and has made the term remission a topic of discussion in many scientific publications and in patient–physician encounters.

In systemic lupus erythematosus (SLE), the concept of remission has also been discussed extensively. Remission in SLE is widely understood as a desirable disease state that should …

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