Prolonged remission in systemic lupus erythematosus.
OBJECTIVE
To determine the frequency of prolonged remission in systemic lupus erythematosus (SLE) using strict criteria for remission and to define disease characteristics and prognosis of patients achieving this state. To also determine the frequency of remission utilizing less restrictive definitions, such as allowing shorter period of disease quiescence, persistence of serological activity, or treatment in the absence of clinical disease.


METHODS
Patients registered in the Lupus Clinic database between 1970 and 1997 with visits no more than 18 months apart were identified. Prolonged remission was defined as a 5-year consecutive period of no disease activity (SLE disease activity index, SLEDAI = 0) and without treatment (corticosteroids, antimalarials, or immunosuppressants). Prolonged serologically active, clinically quiescent (SACQ) was defined as active serology (elevated anti-dsDNA by Farr assay or hypocomplementemia) but no clinical activity on SLEDAI and no treatment.


RESULTS
Seven hundred and three patients fulfilled inclusion criteria. Of the 703 patients 46 (6.5%) achieved complete remission for at least 1 year, whereas only 12 patients (1.7%) had prolonged complete remission of at least 5 years on no treatment. Although the frequency of disease manifestations was similar to the patients not in remission, the 5-year remission group was distinguished by lower overall disease activity as measured by adjusted mean SLEDAI, lower prevalence of anti-DNA antibodies, and lower use of steroids and antimalarials.


CONCLUSIONS
Prolonged complete remission in lupus is rare. Therefore with current therapies continued vigilance for disease recurrence is necessary.
Urowitz
Murray B
MB
University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, University Health Network, Ontario, Canada. m.urowitz@utoronto.ca
Feletar
Marie
M
Bruce
Ian N
IN
Ibañez
Dominique
D
Gladman
Dafna D
DD
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D000962:Antimalarials / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D016036:Seroepidemiologic Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors
D000974:Antibodies, Antinuclear; D000962:Antimalarials; D007166:Immunosuppressive Agents; D013256:Steroids