Both prolonged remission and Lupus Low Disease Activity State are associated with reduced damage accrual in systemic lupus erythematosus

Rheumatology (Oxford). 2017 Jan;56(1):121-128. doi: 10.1093/rheumatology/kew377. Epub 2016 Nov 1.


Objectives: To identify predictors of organ damage and specifically the relationship between prolonged disease remission or low disease activity and damage accrual in a longitudinal cohort of SLE patients.

Methods: Data were prospectively assessed including the occurrence of minor/major flares. Once a year remission and Lupus Low Disease Activity State (LLDAS) were determined retrospectively. A prediction model for damage accrual during follow-up was constructed with backward logistic regression analyses. Secondly, odds ratios (ORs) for damage accrual (SLICC damage index increase of ⩾ 1 during follow-up) were calculated for patients with or without prolonged remission during 5 years, and with or without LLDAS in ⩾ 50% of observations.

Results: Data from 183 patients with a median follow-up duration of 5.0 years were analysed. The most significant predictors for damage accrual were: occurrence of ⩾ 1 major flare, mean daily prednisone dose during follow-up and nephrological manifestations at baseline. Prolonged remission was present in 32.5% (38/117) and LLDAS in ⩾ 50% of observations in 64.5% (118/183) of patients. Both the presence of prolonged remission during 5 years and LLDAS in ⩾ 50% of observations were associated with a reduced risk of damage accrual (OR = 0.20, 95% CI: 0.07, 0.53, P = 0.001 and OR = 0.52, 95% CI: 0.28, 0.99, P = 0.046, respectively).

Conclusion: This cohort study shows that prolonged remission and LLDAS were associated with an improved outcome, as determined by yearly assessments. In order to improve the outcome in SLE patients, future studies should investigate whether these targets can be reached actively with therapeutic strategies.

Keywords: cohort study; damage accrual; flare; glucocorticoids; low disease activity; lupus low disease activity state; lupus nephritis; remission; systemic lupus erythematosus.

MeSH terms

  • Adult
  • Arthritis / etiology
  • Cataract / chemically induced
  • Cohort Studies
  • Diabetes Mellitus / chemically induced
  • Disease Progression
  • Female
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use
  • Humans
  • Hypertension, Pulmonary / etiology
  • Longitudinal Studies
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / physiopathology*
  • Lupus Nephritis / etiology
  • Male
  • Middle Aged
  • Myelitis, Transverse / etiology
  • Odds Ratio
  • Osteomyelitis / etiology
  • Osteonecrosis / chemically induced
  • Osteoporosis / chemically induced
  • Osteoporotic Fractures / chemically induced
  • Pancreatitis / etiology
  • Prednisone / adverse effects
  • Prednisone / therapeutic use
  • Prospective Studies
  • Remission Induction
  • Retrospective Studies
  • Serositis / etiology
  • Severity of Illness Index
  • Skin Diseases / etiology


  • Glucocorticoids
  • Prednisone