title: The effect of different durations of remission on damage accrual: results from a prospective monocentric cohort of Caucasian patients.
abstract: OBJECTIVE
  To identify the shortest duration of remission associated with improved outcomes in systemic lupus erythematosus (SLE).
  
  
  METHODS
  We studied 293 Caucasian patients with SLE during 7-year follow-up. Disease activity was assessed by SLE Disease Activity Index 2000 and damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We defined three remission levels: complete, clinical off-corticosteroids, clinical on-corticosteroids (prednisone 1-5 mg/day). The effect of different durations of remission (1, 2, 3, 4 and ≥5 consecutive years) on damage was evaluated by multivariate logistic regression analysis.
  
  
  RESULTS
  Among patients achieving 1-year (27 patients), 2-year (47 patients), 3-year (45 patients), 4-year (26 patients) remission, damage was similar irrespective of the level of remission achieved, whereas, among patients achieving ≥5-year remission (113 patients), damage was higher in those in clinical remission on-corticosteroids (p<0.001).In multivariate analysis, ≥2 consecutive year remission was protective against damage (OR (95% CI)): 2 years 0.228 (0.061 to 0.850); 3 years 0.116 (0.031 to 0.436); 4 years 0.118 (0.027 to 0.519) and ≥5 years 0.044 (0.012 to 0.159). Predictors of damage were cumulative prednisone dose ≥180 mg/month (3.136 (1.276 to 7.707)), antiphospholipid antibody syndrome (5.517 (2.092 to 14.546)), vasculitis (3.107 (1.030 to 9.307)) and number of flare/year (8.769 (1.692 to 45.449)).
  
  
  CONCLUSIONS
  Two consecutive years is the shortest duration of remission associated with a decrease in damage progression in Caucasian patients with SLE.
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Zen
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Iaccarino
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Mariele
authors.initials: M
authors.lastname: Gatto
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Bettio
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Saccon
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ghirardello
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D000067251:Symptom Flare Up; D013997:Time Factors; D014657:Vasculitis / Q000150:complications*; D044465:White People; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone
keywords: Disease Activity; Outcomes research; Systemic Lupus Erythematosus