title: Disease activity patterns in a monocentric cohort of SLE patients: a seven-year follow-up study.
abstract: OBJECTIVE
  To evaluate disease activity patterns and flare occurrence in a cohort of systemic lupus erythematosus (SLE) patients.
  
  
  METHODS
  Patients registered in our lupus Database, diagnosed with SLE between 1991 and 2004 and followed up quarterly from 2004 to 2010 were considered in the study. Disease activity patterns were defined using SLE Disease Activity Index-2000 (SLEDAI-2K), excluding serology, as follows: clinical quiescent disease (CQD), SLEDAI-2K=0 in the three annual visits; minimal disease activity (MDA), SLEDAI-2K=1 in one or more annual visits; chronic active disease (CAD), SLEDAI-2K≥2 in at least two annual visits; relapsing-remitting disease (RRD), SLEDAI-2K≥2 in one out of 3 annual visits. Flare was defined as an increase in SLEDAI-2K≥4 from the previous visit, according to SELENA-SLEDAI flare index.
  
  
  RESULTS
  One hundred and sixty-five patients fulfilled the inclusion criteria. During the 7 year follow-up, 109 (66%) patients experienced at least one period of active disease (CAD, RRD and MDA), whereas 56 patients (34%) had a persistent CQD. The mean±SD number of patients in each pattern per year was: CAD 52.4±5.8 (31.7%), RRD 16.1±6.8 (9.7%), MDA 9.7±1.7, (5.9%), CQD 87±10.5 (52.6%). Annual flare-rate was 0.19 flare per patient/year and mean±SD number of flares was higher in CAD compared with RRD patients (p<0.01). At the multivariate analysis positive anti-dsDNA antibodies, low C3 or C4, male sex, longer lag time between SLE onset and diagnosis, higher number of flares, and use of immunosuppressant were independently associated with active disease including CAD and RRD patterns.
  
  
  CONCLUSIONS
  Two-thirds of our patients developed at least one period of active disease during the 7-year follow-up despite tight monitoring and standard treatment.
authors: Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy. margimeg@libero.it
authors: Margherita
authors: M
authors: Zen
authors: Nicola
authors: N
authors: Bassi
authors: Linda
authors: L
authors: Nalotto
authors: Mariagrazia
authors: M
authors: Canova
authors: Silvano
authors: S
authors: Bettio
authors: Mariele
authors: M
authors: Gatto
authors: Anna
authors: A
authors: Ghirardello
authors: Luca
authors: L
authors: Iaccarino
authors: Leonardo
authors: L
authors: Punzi
authors: Andrea
authors: A
authors: Doria
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000974:Antibodies, Antinuclear / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004247:DNA / Q000276:immunology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007558:Italy; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000974:Antibodies, Antinuclear; D015415:Biomarkers; D007166:Immunosuppressive Agents; D004247:DNA