Frequency and predictors of the lupus low disease activity state in a multi-national and multi-ethnic cohort.
Systemic lupus erythematosus (SLE) is a chronic heterogeneous disease with considerable burden from disease activity and damage. A novel clinical treatment target in the form of the lupus low disease activity state (LLDAS) has been recently reported, with retrospective validation showing that time spent in LLDAS translates to reduced damage accrual. The objectives of this study were to describe the frequency and identify the predictors of attaining LLDAS in a large multinational cohort of patients with SLE.



Data were collected at the recruitment visit in patients with SLE enrolled in a longitudinal study in nine countries. Data were analysed cross-sectionally against the recently published definition of LLDAS, and the frequency and characteristics associated with presence of LLDAS were determined. Stepwise multivariable logistic regression was used to determine predictors of LLDAS.



Of the 1846 patients assessed, criteria for LLDAS were met by 44 %. Patients with shorter disease duration were less likely to be in LLDAS (OR 0.31, 95 % CI 0.19-0.49, p < 0.001). Likewise, patients with a history of discoid rash (OR 0.66, 95 % CI 0.49-0.89, p = 0.006), renal disease (OR 0.60, 95 % CI 0.48-0.75, p < 0.001), elevated double stranded DNA (OR 0.65, 95 % CI 0.53-0.81, p < 0.001) or hypocomplementaemia (OR 0.52, 95 % CI 0.40-0.67, p < 0.001) were less likely to be in LLDAS. When countries were compared, higher national social wealth (OR 1.57, 95 % CI 1.25-1.98, p < 0.001) as measured by the gross domestic product per capita was positively associated with LLDAS, but ethnicity was not.



The lupus low disease activity state is observed in less than half of patients with SLE at a single point in time. Disease duration and phenotype, and national social wealth, are predictive of LLDAS.
Monash University, Melbourne, Australia. vera.golder@monash.edu.
Vera
0000-0001-5691-4344
V
Golder
Monash University, Melbourne, Australia.
Rangi
R
Kandane-Rathnayake
Monash University, Melbourne, Australia.
Alberta Yik-Bun
AY
Hoi
The University of Melbourne, Melbourne, Australia.
Molla
M
Huq
Chiang Mai University Hospital, Chiang Mai, Thailand.
Worawit
W
Louthrenoo
People's Hospital Peking University Health Sciences Center, Beijing, China.
Yuan
Y
An
People's Hospital Peking University Health Sciences Center, Beijing, China.
Zhan Guo
ZG
Li
Chang Gung Memorial Hospital, Guishan Township, Taiwan.
Shue Fen
SF
Luo
University of Malaya, Kuala Lumpur, Malaysia.
Sargunan
S
Sockalingam
University of Hong Kong, Hong Kong, Hong Kong.
Chak Sing
CS
Lau
University of Hong Kong, Hong Kong, Hong Kong.
Alfred Lok
AL
Lee
University of Hong Kong, Hong Kong, Hong Kong.
Mo Yin
MY
Mok
National University Hospital, Singapore, Singapore.
Aisha
A
Lateef
Monash University, Melbourne, Australia.
Kate
K
Franklyn
Monash Health, Melbourne, Australia.
Susan
S
Morton
University of Santo Tomas Hospital, Manila, Philippines.
Sandra Teresa V
ST
Navarra
University of Santo Tomas Hospital, Manila, Philippines.
Leonid
L
Zamora
Chang Gung Memorial Hospital, Guishan Township, Taiwan.
Yeong-Jian
YJ
Wu
University of Padjadjaran, Bandung, Indonesia.
Laniyati
L
Hamijoyo
Tan Tock Seng Hospital, Singapore, Singapore.
Madelynn
M
Chan
University of New South Wales, Sydney, Australia.
Sean
S
O'Neill
Royal Adelaide Hospital, Adelaide, Australia.
Fiona
F
Goldblatt
Monash University, Melbourne, Australia.
Eric Francis
EF
Morand
The University of Melbourne, Melbourne, Australia.
Mandana
M
Nikpour
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D012720:Severity of Illness Index
Disease activity; Low disease activity; Systemic lupus erythematosus; Treatment target