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Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32-Year Period

Medina-Quinones, CV; Ramos-Merino, L; Ruiz-Sada, P; Isenberg, D; (2016) Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32-Year Period. Arthritis Care and Research , 68 (7) pp. 981-987. 10.1002/acr.22774. Green open access

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Abstract

OBJECTIVE: Systemic lupus erythematosus (SLE) is characterized by an unpredictable and fluctuating course. Although various methods have been developed to measure disease activity, there is still a lack of consensus about the optimal criteria for SLE remission. The principal aim of our study was to identify the number of lupus patients achieving a complete remission (implying that for 3 years there were no clinical or serologic features and no treatment with steroids and immunosuppressive drugs) in a single cohort of patients followed for a period of up to 32 years. In addition, we have identified patients in clinical but not serologic remission (known as serologically active, clinically quiescent disease [SACQ]) and vice versa. We were particularly interested to determine the factors associated with complete remission. METHODS: Eligible patients were followed up in the University College Hospital Lupus cohort from January 1978 until December 2010 for a period of at least 3 years. Complete remission was defined as a period of at least 3 years with clinical inactivity (British Isles Lupus Assessment Group scores of C, D, or E only) and laboratory remission (no antibodies to double-stranded DNA and normal complement C3 levels), and being off-treatment with corticosteroids and immunosuppressants. Antimalarial and nonsteroidal antiinflammatory drugs were allowed. RESULTS: Of 624 lupus patients at our hospital, a total of 532 patients met the strict inclusion criteria for the study. Of these 532 patients, 77 patients (14.5%) achieved complete remission for at least 3 years, and 23 (4.3%) achieved complete remission for a minimum period of 10 years. Ten of these 77 patients were subsequently lost to followup, and, interestingly, flares occurred subsequently in 15 of the 67 remaining patients (22.4%). Three patients relapsed after the tenth year of remission. Forty-five patients (8.5%) fulfilled the requirement for SACQ, and 66 patients (12.4%) achieved only serologic remission. CONCLUSION: Our study indicated that 14.5% of lupus patients achieved a complete remission for 3 years. However, flares may continue to occur beyond 10 years of remission. Long-term followup of SLE is therefore mandatory.

Type: Article
Title: Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32-Year Period
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/acr.22774
Publisher version: http://dx.doi.org/10.1002/acr.22774
Language: English
Additional information: Copyright © 2016 American College of Rheumatology. This is the peer reviewed version of the following article: Medina-Quiñones, CV; Ramos-Merino, L; Ruiz-Sada, P; Isenberg, DA; (2016) Analysis of complete remission in systemic lupus erythematosus patients over a 32-year period. Arthritis Care and Research, 68 (7) pp. 981-987, which has been published in final form at: http://dx.doi.org/10.1002/acr.22774. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html#terms).
Keywords: Science & Technology, Life Sciences & Biomedicine, Rheumatology, Disease-activity, Bilag Index, Damage, Hydroxychloroquine, Validation, Mortality, Cohort
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation
URI: https://discovery.ucl.ac.uk/id/eprint/1536414
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