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The effect of different durations of remission on damage accrual: results from a prospective monocentric cohort of Caucasian patients
  1. Margherita Zen,
  2. Luca Iaccarino,
  3. Mariele Gatto,
  4. Silvano Bettio,
  5. Francesca Saccon,
  6. Anna Ghirardello,
  7. Leonardo Punzi,
  8. Andrea Doria
  1. Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
  1. Correspondence to Professor Andrea Doria, Division of Rheumatology, Department of Medicine, University of Padova, Via Giustiniani, 2, Padova 35128, Italy; adoria{at}


Aim To identify the shortest duration of remission associated with improved outcomes in systemic lupus erythematosus (SLE).

Methods We studied 293 Caucasian patients with SLE during 7-year follow-up. Disease activity was assessed by SLE Disease Activity Index 2000 and damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We defined three remission levels: complete, clinical off-corticosteroids, clinical on-corticosteroids (prednisone 1–5 mg/day). The effect of different durations of remission (1, 2, 3, 4 and ≥5 consecutive years) on damage was evaluated by multivariate logistic regression analysis.

Results Among patients achieving 1-year (27 patients), 2-year (47 patients), 3-year (45 patients), 4-year (26 patients) remission, damage was similar irrespective of the level of remission achieved, whereas, among patients achieving ≥5-year remission (113 patients), damage was higher in those in clinical remission on-corticosteroids (p<0.001).

In multivariate analysis, ≥2 consecutive year remission was protective against damage (OR (95% CI)): 2 years 0.228 (0.061 to 0.850); 3 years 0.116 (0.031 to 0.436); 4 years 0.118 (0.027 to 0.519) and ≥5 years 0.044 (0.012 to 0.159). Predictors of damage were cumulative prednisone dose ≥180 mg/month (3.136 (1.276 to 7.707)), antiphospholipid antibody syndrome (5.517 (2.092 to 14.546)), vasculitis (3.107 (1.030 to 9.307)) and number of flare/year (8.769 (1.692 to 45.449)).

Conclusions Two consecutive years is the shortest duration of remission associated with a decrease in damage progression in Caucasian patients with SLE.

  • Systemic Lupus Erythematosus
  • Outcomes research
  • Disease Activity

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  • Handling editor Tore K Kvien

  • Contributors MZ contributed to the conception and design of the work, the follow-up of patients, acquisition, analysis and interpretation of data and drafted the work; LI and MG followed up patients and gave their contribution in drafting the work; SB and FS contributed to the follow-up of patients and helped in the acquisition of data; AG helped in the analysis of data; LP critically revised the final work and AD led the team who followed up patients, designed the work, interpreted the data, drafted and revised the manuscript for important intellectual content. All the authors approved the final version of the manuscript and gave their agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Ethics Committee of the ‘Azienda Ospedaliera-Università degli Studi di Padova’, Padova, Italy. Participants gave informed consent before taking part to the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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