Background/Purpose: We have previously shown that prolonged clinical remission for ≥10 years is associated with significantly less damage accrual in inception patients with systemic lupus erythematosus (SLE)¹. However, most lupus patients (approximately 70%) will follow a relapsing-remitting disease course pattern with greatly varying duration of remission over time. The aim of the present study was to assess the optimal duration of clinical remission in inception lupus patients and investigate its effect on damage accrual.

Methods: Inception SLE patients (time from diagnosis to first clinic visit ≤18 months) with at least 10 years of follow-up who had a relapsing-remitting pattern (≥2 distinct clinical flares over that decade) were retrieved from our long-term longitudinal database. Optimal duration of remission during the first decade of disease for the outcome of new damage accrual was established from a Logistic regression analysis (Receiver Operating Characteristic curve, ROC). Subsequently, subjects were divided into two groups according to the optimal remission duration (defined as clinical SLEDAI-2K=0 regardless of therapy). Groups were compared for percentage of patients with new damage accrual at 10 years, mean Damage Index, atherosclerotic vascular events (AVEs), osteonecrosis, osteoporosis and cumulative glucocorticoid dose. Outcomes were compared by Student’s t-test for mean values and Chi-Square test for binary variables.

Results: Two hundred patients were retrieved. Remission duration of 7.1 years yielded the best threshold based on the ROC analysis using Youden index as the selection criterion (specificity 82%, sensitivity 33%). Patients were divided into groups A (time in remission ≤7.1 years) and B ( >7.1 years). Patients in group A had significantly less mucocutaneous involvement; there were no significant differences regarding the other demographic, clinical, immunological and therapeutic variables at baseline (Table 1). Outcomes are shown in Table 2. Group B received significantly less glucocorticoids than group A and accrued significantly less damage. Osteoporosis was significantly less frequent in these patients. The prevalence of atherosclerotic vascular events and osteonecrosis was also less although insignificantly.

Conclusion: Among inception patients with SLE, clinical remission of at least 7.1 years is associated with significantly less damage over 10 years than shorter remission. While the difference in AVEs was not statistically significant, this comorbidity usually manifests later in disease course.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-time-in-clinical-remission-on-damage-accrual-in-systemic-lupus-erythematosus/