Background/Purpose: Systemic lupus erythematosus (SLE) is characterized by a variability of disease expression, both between individuals and within individuals, over time. The aim of this study is to identify prognostic factors of persistent disease activity and remission.

Methods: Patients enrolled in the Hopkins Lupus Cohort from 1987 to 2014, who had at least 3 visits per year, at least 3 years follow-up and available information on disease activity were included. Three major patterns of SLE disease activity over time (1 year intervals) have been previously described1,2, as defined by the Modified SLE Disease Activity Index – modified to remove serology (M-SLEDAI): long quiescent (LQ), chronic active (CA) and relapsing-remitting (RR). Based on maintenance of the aforementioned patterns over 3 consecutive years, patterns are defined as: Persistent Long Quiescent (pLQ), LQ pattern in each of the 3 years; Persistent Relapsing-Remitting (pRR), RR pattern in each of the 3 years; Persistent Chronic Active (pCA), CA pattern in each of the 3 years; and Mixed, at least 2 different pattern types. Possible predictors of pCA (vs. pLQ, pRR and mixed) and pLQ (vs. pCA, pRR and mixed) were identified by univariate logistic regression analyses. Several baseline demographic and disease characteristics were used as independent variables. The results from theses analyses (p<0.25 as the criterion) and correlation analyses (Pearson and Spearman correlations) guided the selection of variables for the multivariate logistic regression analyses. The non-significant variables were removed by stepwise backward selection.

Results: 916 patients were identified. The results of the univariate regression analysis for pCA and pLQ are shown in table 1 and 2, respectively. In the multivariate model, African American race (OR: 2.43, 95% CI: 1.19-4.94) and high baseline SLEDAI (OR: 1.09, 95% CI: 1.03-1.16) remained significant predictors of pCA. Higher education (>12 years; OR: 2.16, 95% CI: 1.11-4.20) and low baseline SLEDAI (OR: 0.62, 95% CI: 0.52-0.75) were significant predictors of pLQ in the multivariate analysis while African American race (OR: 0.36, 95% CI: 0.16-0.78) and female patients (OR: 0.26, 95% CI: 0.12-0.56) were less likely to achieve stable remission.

Conclusion: African American race and high disease activity at the time of diagnosis predict chronic activity in SLE, even after adjustment for education years and income, while higher education, low disease activity at baseline and male sex predict long-term remission. References: [1] Györi N, et al. Disease Activity Patterns over Time in Patients with SLE – a Retrospective Descriptive Analysis of the Hopkins Lupus Cohort. ACR 2015. [2] Barr SG, et al. Patterns of disease activity in systemic lupus erythematosus. Arthritis Rheum. Dec 1999;42(12):2682-2688.