PT  - JOURNAL ARTICLE
AU  - Manuel Francisco Ugarte-Gil
AU  - John Hanly
AU  - Murray Urowitz
AU  - Caroline Gordon
AU  - Sang-Cheol Bae
AU  - Juanita Romero-Diaz
AU  - Jorge Sanchez-Guerrero
AU  - Sasha Bernatsky
AU  - Ann Elaine Clarke
AU  - Daniel J Wallace
AU  - David Alan Isenberg
AU  - Anisur Rahman
AU  - Joan T Merrill
AU  - Paul R Fortin
AU  - Dafna D Gladman
AU  - Ian N Bruce
AU  - Michelle Petri
AU  - Ellen M Ginzler
AU  - Mary Anne Dooley
AU  - Rosalind Ramsey-Goldman
AU  - Susan Manzi
AU  - Andreas Jönsen
AU  - Ronald F van Vollenhoven
AU  - Cynthia Aranow
AU  - Meggan Mackay
AU  - Guillermo Ruiz-Irastorza
AU  - Sam Lim
AU  - Murat Inanc
AU  - Ken Kalunian
AU  - Søren Jacobsen
AU  - Christine Peschken
AU  - Diane L Kamen
AU  - Anca Askanase
AU  - Bernardo A Pons-Estel
AU  - Graciela S Alarcón
TI  - Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
AID  - 10.1136/ard-2022-222487
DP  - 2022 Nov 01
TA  - Annals of the Rheumatic Diseases
PG  - 1541--1548
VI  - 81
IP  - 11
4099  - http://ard.bmj.com/content/81/11/1541.short
4100  - http://ard.bmj.com/content/81/11/1541.full
SO  - Ann Rheum Dis2022 Nov 01; 81
AB  - Objective To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual.Methods Patients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K=0, without prednisone or immunosuppressants; remission on-treatment: cSLEDAI-2K score=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; low disease activity Toronto cohort (LDA-TC): cSLEDAI-2K score of ≤2, without prednisone or immunosuppressants; modified lupus low disease activity (mLLDAS): Systemic Lupus Erythematosus Disease Activity Index-2K score of 4 with no activity in major organ/systems, no new disease activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants; active: all remaining visits. Only the most stringent definition was used per visit. Antimalarials were allowed in all. The proportion of time that patients were in a specific state at each visit since cohort entry was determined. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and multivariable generalised estimated equation negative binomial regression models were used. Time-dependent covariates were determined at the same annual visit as the disease activity state but the SDI at the subsequent visit.Results There were 1652 patients, 1464 (88.6%) female, mean age at diagnosis 34.2 (SD 13.4) years and mean follow-up time of 7.7 (SD 4.8) years. Being in remission off-treatment, remission on-treatment, LDA-TC and mLLDAS (per 25% increase) were each associated with a lower probability of damage accrual (remission off-treatment: incidence rate ratio (IRR)=0.75, 95% CI 0.70 to 0.81; remission on-treatment: IRR=0.68, 95% CI 0.62 to 0.75; LDA: IRR=0.79, 95% CI 0.68 to 0.92; and mLLDAS: IRR=0.76, 95% CI 0.65 to 0.89)).Conclusions Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.Data are available upon reasonable request.