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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 273-278. doi: 10.19723/j.issn.1671-167X.2024.02.011

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Low disease activity and remission status of systemic lupus erythematosus in a real-world study

Limin REN1,Chuchu ZHAO1,Yi ZHAO2,Huiqiong ZHOU3,Liyun ZHANG4,Youlian WANG5,Lingxun SHEN6,Wenqiang FAN7,Yang LI8,Xiaomei LI9,Jibo WANG10,Yongjing CHENG11,Jiajing PENG1,Xiaozhen ZHAO1,Miao SHAO1,Ru Li1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
    2. Department of Rheumatology and Immunology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
    3. Department of Rheumatology, the Fourth Medical Center of PLA General Hospital, Beijing 100142, China
    4. Department of Rheumatology, Shanxi Dayi Hospital, Taiyuan 030032, China
    5. Department of Rheumatology, Jiangxi Provincial People's Hospital, Nanchang 330006, China
    6. Department of Immunology and Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
    7. Department of Rheumatology and Immunology, The Fourth Clinical College of Xinxiang Medical University, Xinxiang 453099, Henan, China
    8. Department of Rheumatology and Immunology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150001, China
    9. Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei 230001, China
    10. Department of Rheumatology, The Affliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
    11. Department of Rheumatology and Immunology, Beijing Hospital, Beijing 100730, China
  • Received:2023-03-27 Online:2024-04-18 Published:2024-04-10
  • Contact: Ru Li E-mail:doctorliru123@163.com

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Abstract:

Objective: To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus (SLE) in a real-world setting, and to analyze the related factors of low disease activity and clinical remission. Methods: One thousand patients with SLE were enrolled from 11 teaching hospitals. Demographic, clinical and laboratory data, as well as treatment regimes were collec-ted by self-completed questionnaire. The rates of low disease activity and remission were calculated based on the lupus low disease activity state (LLDAS) and definitions of remission in SLE (DORIS). Charac-teristics of patients with LLDAS and DORIS were analyzed. Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission. Results: 20.7% of patients met the criteria of LLDAS, while 10.4% of patients achieved remission defined by DORIS. Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration, compared with non-remission group. Moreover, the rates of anemia, creatinine elevation, increased erythrocyte sedimentation rate (ESR) and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group. Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission. The results of Logistic regression analysis showed that increased ESR, positive anti-dsDNA antibodies, low level of complement (C3 and C4), proteinuria, low household income were negatively related with LLDAS and DORIS remission. However, hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission. Conclusion: LLDAS and DORIS remission of SLE patients remain to be improved. Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.

Key words: Systemic lupus erythematosus, Remission, Lupus low disease activity state

CLC Number: 

  • R593.24

Table 1

Comparison of clinical characteristics between patients who met or unmet DORIS/LLDAS criteria"

ItemsDORIS (n=104) LLDAS (n=207)
Met Unmet P Met Unmet P
Female 99 (95.2) 819 (91.4) 0.183 196 (94.7) 722 (91.0) 0.089
Age/years 37.3±13.1 37.0±13.5 0.843 37.4±12.8 37.0±13.6 0.713
Northern region 88 (84.6) 723 (80.7) 0.333 171 (82.6) 640 (80.7) 0.534
Married 82 (78.8) 712 (79.5) 0.883 168 (81.2) 626 (78.9) 0.482
Bachelor’s degree or above 71 (68.2) 635 (70.9) 0.582 152 (73.4) 554 (69.9) 0.316
On-the-job 69 (66.3) 548 (61.2) 0.303 138 (66.7) 479 (60.4) 0.099
Outworker 16 (15.3) 134 (15.0) 0.908 23 (11.1) 127 (16.0) 0.078
Household income≥1 000 yuan per month 102 (98.1) 825 (92.1) 0.026 199 (96.1) 728 (91.8) 0.033
Family history 19 (18.2) 112 (12.5) 0.099 28 (13.5) 103 (13.0) 0.838
Disease duration/months 76.2±59.2 58.9±68.4 0.013 72.4±57.4 57.7±69.8 0.005
Increased ESR 34 (32.7) 458 (51.1) ＜0.001 80 (38.6) 412 (52.0) 0.001
Hypoproteinemia 20 (19.2) 368 (41.2) 0.023 59 (28.5) 329 (41.5) 0.001
Anemia 24 (23.1) 297 (33.1) 0.048 59 (28.5) 262 (33.0) 0.213
Elevated creatinine 1 (0.1) 40 (4.5) 0.046 5 (2.4) 36 (4.5) 0.171

Figure 1

Effect of the course of HCQ and IS on the disease activity in SLE patients A, effect of the course of HCQ and IS on SLEDAI-2K scores; B, effect of the course of HCQ on LLDAS and DORIS remission; C, effect of the course of IS on LLDAS and DORIS remission. * P < 0.05, * * P < 0.01, * * * P < 0.001. IS, immunosuppressants; HCQ, hydroxychloroquine; SLE, systemic lupus erythematosus; SLEDAI-2K, SLE disease activity index 2000; LLDAS, lupus low disease activity state; DORIS, definition of remission in SLE."

Table 2

Multivariat Logitstic analysis of factors related LLDAS or DORIS remission in SLE patients"

VariablesLLDAS DORIS
OR (95%CI) P OR (95%CI) P
Increased ESR 0.63 (0.45, 0.88) ＜0.01 0.50 (0.31, 0.81) ＜0.01
Positive anti-dsDNA antibodies 0.40 (0.27, 0.60) ＜0.01 0.24 (0.12, 0.48) ＜0.01
Low complement C3 0.55 (0.37, 0.83) ＜0.01 0.29 (0.15, 0.54) ＜0.01
Low complement C4 0.63 (0.42, 0.94) 0.025 0.32 (0.17, 0.60) ＜0.01
Urine protein≥0.5 g/d 0.31 (0.19, 0.52) ＜0.01 0.21 (0.08, 0.55) ＜0.01
Low household income (＜1 000 yuan per month) 0.44 (0.21, 0.93) 0.028 0.21 (0.05, 0.88) 0.033
HCQ usage for longer than 12 months 3.10 (2.15, 4.45) ＜0.01 2.35 (1.46, 3.78) ＜0.01
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