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Correspondence response
Response to Dr Nikpour's letter
  1. Theresa R Wilhelm1,2,
  2. Laurence S Magder3,
  3. Michelle Petri1
  1. 1Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Videncenter for Reumatologi og Rygsygdomme, Rigshospitalet Glostrup, Glostrup, Denmark
  3. 3Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
  1. Correspondence to Theresa R Wilhelm, Videncenter for Reumatologi og Rygsygdomme, Rigshospitalet Glostrup, Nordre Ringvej 57, 2600 Glostrup, Denmark; theresa.rita.wilhelm{at}

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We thank Dr Nikpour for her comment1 concerning our recent publication ‘Remission in systemic lupus erythematosus: durable remission is rare’.2

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.

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