Background/Purpose:  To study the effect of disease remission on quality of life and organ damage in patients with systemic lupus erythematosus.

Methods:  Consecutive patients who fulfilled the ACR classification for SLE were recruited from our lupus out-patient clinics. Their remission status was determined according to the European consensus (DORIS definition): (1) Complete remission (clinical SLEDAI=0, serology inactive); and (2) Clinical remission (clinical SLEDAI=0, serology active). These two categories were further divided into those who required ongoing immunosuppressive treatment (prednisone ≤5mg/d or other immunosuppressive agents) and who did not. The duration of the remission status was also verified by medical record review. The increase in SLE organ damage (SDI) score since 5 years prior to recruitment was compared between patients who were and were not in clinical remission for at least 5 years. Participants were randomly selected for assessment of quality of life by using both the validated version of SF36 and the LupusPRO (version 1.8) and comparison was made between those who did and did not achieve clinical remission for ≥5 years by the independent Students’ t-test.

Results: A total of 618 SLE patients were studied (92% women; age 45.5±8.1 years, SLE duration 11.8±8.1 years). All were ethnic Chinese. At the last clinic visit, clinical remission (serology active) was present in 227 (37%) patients (median duration 28 months) and complete remission (clinical and serology inactive) was present in 232 (38%) patients (median duration 48 months). Clinical and complete remission for ≥5years was achieved in 55 (9%) and 98 (16%) of the patients, respectively. 40 (26%) patients with remission ≥5 years were taken off all medications. No significant differences in the cumulative frequencies of organ manifestations since SLE diagnosis were observed between patients with clinical/complete remission for ≥5years and <5 years. However, patients with remission ≥5 years were significantly older (48.6±13.5 vs 44.5±14.7 years; p=0.002) and had a longer SLE duration (16.8±7.8 vs 10.3±7.5 years; p<0.001). In patients with remission for ≥5years, the increase in SDI score over the preceding 5 years was significantly lower than those with remission for <5 years (0.18±0.47 vs 0.50±0.90; p<0.001). 88 patients with remission ≥5 years and 283 patients with remission <5 years were assessed for quality of life at random. The physical component (61.7±21.6 vs 53.6±21.1; p=0.03) and mental component (61.0±21.8 vs 54.6±20.9; p=0.02) scores of the SF36 were significantly higher in patients with remission ≥5 years. On the other hand, scores of the health related domains (81.1±15.7 vs 73.1±16.1; p<0.001) but not the non-health related domains (57.6±18.4 vs 58.6±14.8; p=0.64) of the Chinese LupusPRO were significantly higher in patients with remission ≥5 years compared to those with remission <5 years. 

Conclusion: In this cross-sectional study of Chinese patients with SLE, long-lasting clinical remission was present in a quarter of patients, the majority of whom were on maintenance immunosuppressive medications. Those with clinical remission for more than 5 years had less organ damage accrual over time and better health related quality of life.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-disease-remission-on-organ-damage-and-quality-of-life-in-chinese-patients-with-systemic-lupus-erythematosus/