Email Alert | RSS

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

Previous Articles     Next Articles

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

RICH HTML

   

PDF (PC)

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
1 Ugarte-Gil M , Wojdyla D , Pons-Estel GJ , et al. Remission and low disease activity status (LDAS) protect lupus patients from damage occurrence: Data from a multiethnic, multinational Latin American lupus cohort (GLADEL)[J]. Ann Rheum Dis, 2017, 76 (12): 2071- 2074.
doi: 10.1136/annrheumdis-2017-211814
2 Floris A , Piga M , Perra D , et al. Treatment target in newly diagnosed systemic lupus erythematosus: The association of lupus low disease activity state and remission with lower accrual of early damage[J]. Arthritis Care Res (Hoboken), 2020, 72 (12): 1794- 1799.
doi: 10.1002/acr.24086
3 Franklyn K , Lau CS , Navarra SV , et al. Definition and initial validation of a lupus low disease activity state (LLDAS)[J]. Ann Rheum Dis, 2015, 75 (9): 1615- 1621.
4 van Vollenhoven RF , Voskuyl A , Bertsias G , et al. A framework for remission in SLE: Consensus findings from a large international task force on definitions of remission in SLE (DORIS)[J]. Ann Rheum Dis, 2017, 76 (3): 554- 561.
doi: 10.1136/annrheumdis-2016-209519
5 van Vollenhoven RF , Bertsias G , Doria A , et al. 2021 DORIS definition of remission in SLE: Final recommendations from an international task force[J]. Lupus Sci Med, 2021, 8 (1): e000538.
doi: 10.1136/lupus-2021-000538
6 Tsang-A-Sjoe MW , Bultink IE , Heslinga M , et al. Both prolonged remission and lupus low disease activity state are associated with reduced damage accrual in systemic lupus erythematosus[J]. Rheumatology (Oxford), 2017, 56 (1): 121- 128.
doi: 10.1093/rheumatology/kew377
7 Smith EMD , Tharmaratnam K , Al-Abadi E , et al. Attainment of low disease activity and remission targets reduces the risk of severe flare and new damage in childhood lupus[J]. Rheumatology (Oxford), 2022, 61 (8): 3378- 3389.
doi: 10.1093/rheumatology/keab915
8 Zen M , Iaccarino L , Gatto M , et al. Prolonged remission in Caucasian patients with SLE: Prevalence and outcomes[J]. Ann Rheum Dis, 2015, 74 (12): 2117- 2122.
doi: 10.1136/annrheumdis-2015-207347
9 Ugarte-Gil M , Wojdyla D , Pons-Estel G , et al. Predictors of remission and low disease activity state in systemic lupus erythematosus: Data from a multiethnic, multinational Latin American cohort[J]. J Rheumatol, 2019, 46 (10): 1299- 1308.
doi: 10.3899/jrheum.180433
10 Gao D , Hao YJ , Mu L , et al. Frequencies and predictors of the lupus low disease activity state and remission in treatment: Naive patients with systemic lupus erythematosus[J]. Rheumatology (Oxford), 2020, 59 (11): 3400- 3407.
doi: 10.1093/rheumatology/keaa120
11 Ngamjanyaporn P , McCarthy EM , Sergeant JC , et al. Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey[J]. Lupus Sci Med, 2017, 4 (1): e000173.
doi: 10.1136/lupus-2016-000173
12 Bernatsky S , Peschken C , Fortin PR , et al. Medication use in systemic lupus erythematosus[J]. Journal Rheumatol, 2011, 38 (2): 271- 274.
doi: 10.3899/jrheum.100414
13 Golder V , Kandane-Rathnayake R , Huq M , et al. Evaluation of remission definitions for systemic lupus erythematosus: A prospective cohort study[J]. Lancet Rheumatol, 2019, 1 (2): e103- e110.
doi: 10.1016/S2665-9913(19)30048-7
14 Petri M , Magder LS . Comparison of remission and lupus low disease activity state in damage prevention in a United States systemic lupus erythematosus cohort[J]. Arthritis Rheumatol, 2018, 70 (11): 1790- 1795.
doi: 10.1002/art.40571
15 Tani C , Zucchi D , Haase I , et al. Are remission and low disease activity state ideal targets for pregnancy planning in systemic lupus erythematosus? A multicentre study[J]. Rheumatology (Oxford), 2021, 60 (12): 5610- 5619.
[1] Zhihui WU, Mingzhi HU, Qiaoying ZHAO, Fengfeng LV, Jingying ZHANG, Wei ZHANG, Yongfu WANG, Xiaolin SUN, Hui WANG. Immunomodulatory mechanism of umbilical cord mesenchymal stem cells modified by miR-125b-5p in systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 860-867.
[2] Hai-hong YAO,Fan YANG,Su-mei TANG,Xia ZHANG,Jing HE,Yuan JIA. Clinical characteristics and diagnostic indicators of macrophage activation syndrome in patients with systemic lupus erythematosus and adult-onset Still's disease [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 966-974.
[3] Zhi-jun LUO,Jia-jia WU,You SONG,Chun-li MEI,Rong DU. Systemic lupus erythematosus associated macrophage activation syndrome with neuropsychiatric symptoms: A report of 2 cases [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1111-1117.
[4] Xiang-ge ZHAO,Jia-qing LIU,Hui-na HUANG,Zhi-min LU,Zi-ran BAI,Xia LI,Jing-jing QI. Interferon-α mediating the functional damage of CD56dimCD57+natural killer cells in peripheral blood of systemic lupus erythematosuss [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 975-981.
[5] Miao SHAO,Hui-fang GUO,Ling-yan LEI,Qing ZHAO,Yan-jie DING,Jin LIN,Rui WU,Feng YU,Yu-cui LI,Hua-li MIAO,Li-yun ZHANG,Yan DU,Rui-ying JIAO,Li-xia PANG,Li LONG,Zhan-guo LI,Ru LI. A multicenter study on the tolerance of intravenous low-dose cyclophosphamide in systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1112-1116.
[6] Min LI,Lin-qing HOU,Yue-bo JIN,Jing HE. Clinical and immunological characteristics of systemic lupus erythematosus with retinopathy [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1106-1111.
[7] Lin-qi ZHANG,Jing ZHAO,Hong-yan WANG,Zong-yi WANG,Ying-ni LI,Ji-yang TANG,Si-ying LI,Jin-feng QU,Ming-wei ZHAO. Relationship between anti-ENO1 antibody and systemic lupus erythematosus patients with retinopathy [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1099-1105.
[8] Jian-mei ZOU,Li-jun WU,Cai-nan LUO,Ya-mei SHI,Xue WU. Relationship of serum 25- hydroxy vitamin D and systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 938-941.
[9] XIA Fang-fang,LU Fu-ai,LV Hui-min,YANG Guo-an,LIU Yuan. Clinical characteristics and related factors of systemic lupus erythematosus with interstitial pneumonia [J]. Journal of Peking University (Health Sciences), 2021, 53(2): 266-272.
[10] Yan GENG,Bo-rui LI,Zhuo-li ZHANG. Musculoskeletal ultrasound findings of symptomatic joints in patients with systemic lupus erythematosus [J]. Journal of Peking University(Health Sciences), 2020, 52(1): 163-168.
[11] Yu-hua WANG,Guo-hua ZHANG,Ling-ling ZHANG,Jun-li LUO,Lan GAO. Adrenal hemorrhage in a patient with systemic lupus erythematosus [J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1178-1181.
[12] Ying-ni LI,Xiao-hong XIANG,Jing ZHAO,Yun LI,Feng SUN,Hong-yan WANG,Ru-lin JIA,Fan-lei HU. Significance of anti-carbamylated fibrinogen antibodies in systemic lupus erythematosus [J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1019-1024.
[13] Hai-hong YAO,Yi-ni WANG,Xia ZHANG,Jin-xia ZHAO,Yuan JIA,Zhao WANG,Zhan-guo LI. Clinical characteristics and treatment outcomes of macrophage activation syndrome in adults: A case series of 67 patients [J]. Journal of Peking University(Health Sciences), 2019, 51(6): 996-1002.
[14] Fan YANG,Yun-shan ZHOU,Yuan JIA. Systemic lupus erythematosus with acquired hemophilia A: a case report [J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1108-1111.
[15] Xiao-hui ZHANG,Xue-rong DENG,Fan Li,Ying ZHU,Zhuo-li ZHANG. Posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a case report [J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1102-1107.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd