Background/Purpose: Systemic Lupus Erythematosus (SLE) presents a highly heterogeneous clinical course and prognosis. In line with EULAR recommendations and treat-to-target (T2T) strategies, comprehensive assessment of disease activity, organ damage, and patient-reported outcomes (PROs) is essential to optimizing long-term patient care.This study aimed to analyze the correlation between disease activity, organ damage, and PROs in a well-characterized cohort of SLE patients, providing insights into clinical management and functional outcomes.

Methods: We conducted an observational, cross-sectional study including the first 208 consecutive SLE patients assessed under a prospective Treat-to-Target (T2T) strategy from March 31, 2023, at a university hospital in Northern Spain.Disease activity was measured using the SLE Disease Activity Index 2000 (SLEDAI-2K) and SLE-Disease Activity Score (SLE-DAS). Remission was defined according to DORIS criteria (clinical SLEDAI-2K = 0, Physician Global Assessment (PGA) = 0). Lupus Low-Disease Activity State (LLDAS) was defined as SLEDAI-2K ≤4, no disease activity in major organ systems, no new disease activity compared to previous evaluations, PGA ≤1, and prednisone ≤7.5 mg/day.Organ damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI, SDI). Patient-reported outcomes (PROs) included the Health Assessment Questionnaire (HAQ) and Lupus Impact Tracker (LIT).Data are presented as percentages, mean±SD, or median [IQR], as appropriate. Correlations between HAQ, SDI, and remission criteria (DORIS and LLDAS) were analyzed to explore their interrelationship in clinical practice.

Results: We analyzed 208 SLE patients (86.5% women, mean age 46.9 ± 14.3 years). After a median follow-up of 145 [53–361] months, lupus nephritis was present in 60 (28.8%), corticosteroids were used by 88 (42.3%), and antimalarials by 164 (78.8%). At evaluation, 116 (55.7%) met DORIS remission criteria, while 58 (27.9%) were in LLDAS. Organ damage (SDI) was observed in 38 (18.2%) with SDI ≥1 and in 53 (25.4%) with SDI ≥2. Notably, 55.9% of non-remission patients had SDI = 0, indicating variability in disease progression. Among patients in remission, 86.2% had a HAQ score between 0 and 1, versus 47.1% of non-remission patients.

Conclusion: While 55.7% achieved DORIS-defined remission, nearly half had organ damage (SDI ≥1), highlighting a weak correlation between disease activity indices and organ damage. Concurrent assessment of both measures is essential. The stronger correlation between HAQ and SDI suggests PROs may better reflect disease burden than activity indices alone.

Table 1. General features of patients and clinical outcome of 208 patients with Systemic Lupus Erythematosus (SLE).

Table 2. A comparative table between remission according to DORIS, Lupus Low Disease Activity (LLDAS) and organ damage involvement and HAQ.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlation-between-activity-index-organ-damage-index-and-haq-in-systemic-lupus-erythematosus-a-single-center-study/