title: Remission in systemic lupus erythematosus: durable remission is rare.
abstract: BACKGROUND
  Remission is the ultimate goal in systemic lupus erythematosus (SLE). In this study, we applied four definitions of remission agreed on by an international collaboration (Definitions of Remission in SLE, DORIS) to a large clinical cohort to estimate rates and predictors of remission.
  
  
  METHODS
  We applied the DORIS definitions of Clinical Remission, Complete Remission (requiring negative serologies), Clinical Remission on treatment (ROT) and Complete ROT. 2307 patients entered the cohort from 1987 to 2014 and were seen at least quarterly. Patients not in remission at cohort entry were followed prospectively. We used the Kaplan-Meier approach to estimate the time to remission and the time from remission to relapse. Cox regression was used to identify baseline factors associated with time to remission, adjusting for baseline disease activity and baseline treatment.
  
  
  RESULTS
  The median time to remission was 8.7, 11.0, 1.8 and 3.1 years for Clinical Remission, Complete Remission, Clinical ROT and Complete ROT, respectively. High baseline treatment was the major predictor of a longer time to remission, followed by high baseline activity. The median duration of remission for all definitions was 3 months. African-American ethnicity, baseline low C3 and baseline haematological activity were associated with longer time to remission for all definitions. Baseline anti-dsDNA and baseline low C4 were associated with longer time to Complete Remission and Complete ROT. Baseline low C4 was also negatively associated with Clinical Remission.
  
  
  CONCLUSIONS
  Our results provide further insights into the frequency and duration of remission in SLE and call attention to the major role of baseline activity and baseline treatment in predicting remission.
authors: Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.|Videncenter for Reumatologi og Rygsygdomme, Rigshospitalet Glostrup, Glostrup, Denmark.
authors: Theresa R
authors: TR
authors: Wilhelm
authors: Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA.
authors: Laurence S
authors: LS
authors: Magder
authors: Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Michelle
authors: M
authors: Petri
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000974:Antibodies, Antinuclear / Q000097:blood; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D004247:DNA / Q000276:immunology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008180:Lupus Erythematosus, Systemic / Q000097:blood* / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011241:Prednisone / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012074:Remission Induction; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D000974:Antibodies, Antinuclear; D003176:Complement C3; D003181:Complement C4; D007166:Immunosuppressive Agents; D004247:DNA; D011241:Prednisone
keywords: Disease Activity; Outcomes research; Systemic Lupus Erythematosus