title: A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS).
abstract: OBJECTIVE
  Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE.
  
  
  METHODS
  An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%.
  
  
  RESULTS
  The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions:1. Definitions of remission will be worded as follows:remission in SLE is a durable state characterised by…………………. (reference to symptoms, signs, routine labs).2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment.3. Distinction is made between remission off and on therapy:remission off therapyrequires the patient to be on no other treatment for SLE than maintenance antimalarials; andremission on therapyallows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics.The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life.
  
  
  CONCLUSIONS
  The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes.
authors.affiliation: Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, D1:00 Karolinska University Hospital, Solna, Stockholm, Sweden.|Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ronald
authors.initials: R
authors.lastname: van Vollenhoven
authors.affiliation: Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Voskuyl
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklion, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Bertsias
authors.affiliation: Feinstein Institute for Medical Research, Manhasset, New York, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aranow
authors.affiliation: Department of Medicine III, University Medical Center TU Dresden, Dresden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Aringer
authors.affiliation: Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, D1:00 Karolinska University Hospital, Solna, Stockholm, Sweden.
authors.forename: Laurent
authors.initials: L
authors.lastname: Arnaud
authors.affiliation: New York University, New York, USA.
authors.forename: Anca
authors.initials: A
authors.lastname: Askanase
authors.affiliation: LPRe SR-Klub Motýlik, Bratislava, Slovakia.
authors.forename: Petra
authors.initials: P
authors.lastname: Balážová
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfa
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.affiliation: Department of Medicine and Joint Academic Rheumatology Program Medical School, National and Kapodestrian University of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Boumpas
authors.affiliation: NIHR Manchester Biomedical Research Unit, The University of Manchester and Central Manchester Foundation Trust, Manchester, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Bruce
authors.affiliation: Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Cervera
authors.affiliation: Division of Rheumatology, The Arthritis Society Chair in Rheumatic Diseases Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Lupus Foundation of America, Washington DC, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Coney
authors.affiliation: Université Paris-Decartes, Paris, France.|AP-HP, Hôpital Cochin, service de médecine interne, centre de reference maladies auto-immunes et systémiques rares, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: Department of Rheumatology and Immunology, Institute of Bioanalysis, Institute of Family Medicine, University of Pécs, Pécs, Hungary.|Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Czirják
authors.affiliation: Department Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Ronald
authors.initials: R
authors.lastname: Derksen
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.affiliation: Department Medicine/Rheumatology and Clinical Immunology, Charite Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Dörner
authors.affiliation: Polyclinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fischer-Betz
authors.affiliation: Department Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Ruth
authors.initials: R
authors.lastname: Fritsch-Stork
authors.affiliation: Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gordon
authors.affiliation: Division of Rheumatology, Medical University of Graz, Graz, Austria.
authors.forename: Winfried
authors.initials: W
authors.lastname: Graninger
authors.affiliation: Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, D1:00 Karolinska University Hospital, Solna, Stockholm, Sweden.
authors.forename: Noémi
authors.initials: N
authors.lastname: Györi
authors.affiliation: Service de Rhumatologie, Cliniques universitaires Saint-Luc, Pôle de pathologies rhumatismales inflammatoires et systémiques, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Bruxelles, Belgium.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Houssiau
authors.affiliation: Department of Medicine, The Centre for Rheumatology, University College London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Isenberg
authors.affiliation: Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark.
authors.forename: Soren
authors.initials: S
authors.lastname: Jacobsen
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge, UK.
authors.forename: David
authors.initials: D
authors.lastname: Jayne
authors.affiliation: Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, Mainz, Germany.
authors.forename: Annegret
authors.initials: A
authors.lastname: Kuhn
authors.affiliation: Université Paris-Decartes, Paris, France.|AP-HP, Hôpital Cochin, service de médecine interne, centre de reference maladies auto-immunes et systémiques rares, Paris, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Le Guern
authors.affiliation: LUPUS EUROPE, co-opted trustee for research, Essex UK.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lerstrøm
authors.affiliation: Rheumatology Department, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Roger
authors.initials: R
authors.lastname: Levy
authors.affiliation: Rheumatology Department, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Francinne
authors.initials: F
authors.lastname: Machado-Ribeiro
authors.affiliation: Université Paris-Sud; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-sud; INSERM U1184, Le Kremlin Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.affiliation: Bone Densitometry Unit, Monla Hospital, Tripoli, Lebanon.
authors.forename: Jamil
authors.initials: J
authors.lastname: Missaykeh
authors.affiliation: Monash University, Faculty of Medicine, Nursing & Health Sciences, Monash Medical Centre, Clayton, Australia.
authors.forename: Eric
authors.initials: E
authors.lastname: Morand
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Mosca
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Inanc
authors.affiliation: University of Santo Tomas, Manila, Philippines.
authors.forename: Sandra
authors.initials: S
authors.lastname: Navarra
authors.affiliation: Vasculitis.at, Vienna, Austria.
authors.forename: Irmgard
authors.initials: I
authors.lastname: Neumann
authors.affiliation: Department of Connective Tissues Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
authors.forename: Marzena
authors.initials: M
authors.lastname: Olesinska
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.affiliation: Department of Medicine, The Centre for Rheumatology, University College London, UK.
authors.forename: Anisur
authors.initials: A
authors.lastname: Rahman
authors.affiliation: RNA and Molecular Pathology Research Group, Institute of Medical Biology, Health Science Faculty, University of Tromsø, Tromsø, Norway.
authors.forename: Ole Petter
authors.initials: OP
authors.lastname: Rekvig
authors.affiliation: National Institute for Rheumatic Diseases, Piešťany, Slovak Republic.
authors.forename: Jozef
authors.initials: J
authors.lastname: Rovensky
authors.affiliation: Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center (Affiliated to Tel-Aviv University), Tel-Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.|2nd Department of Medicine, Hietzing Hospital, Vienna, Austria.
authors.forename: Josef
authors.identifier: http://orcid.org/0000-0002-8899-9087
authors.initials: J
authors.lastname: Smolen
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, U.O. Reumatologia e Immunolgia Clinica, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, Senior Scientist Krembil Research Institute, Professor Medicine, University of Toronto, Toronto Western Hospital EW 1-409, Toronto, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Urowitz
authors.affiliation: LUPUS EUROPE, co-opted trustee for research, Essex UK.
authors.forename: Bernadette
authors.initials: B
authors.lastname: van Leeuw
authors.affiliation: Unidade de Imunologia Clínica, Hospital Santo António, Centro Hospitalar do Porto, UMIB, Instituto de Ciencias Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vasconcelos
authors.affiliation: Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Voss
authors.affiliation: Corporal Michael J. Crescenz VA Medical Center (Philadelphia), Philadelphia, Philadelphia, USA.|Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
authors.affiliation: Nephrology Unit, City Clinical Hospital n.a. S.P. Botkin, Moscow, Russia.
authors.forename: Helena
authors.initials: H
authors.lastname: Zakharova
authors.affiliation: Lanarkshire Centre for Rheumatology, Hairmyres Hospital, Scotland, UK.
authors.forename: Asad
authors.initials: A
authors.lastname: Zoma
authors.affiliation: Polyclinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
authors.affiliation: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ward
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000974:Antibodies, Antinuclear / Q000097:blood; D000962:Antimalarials / Q000627:therapeutic use; D003165:Complement System Proteins / Q000378:metabolism; D032921:Consensus; D004247:DNA / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000188:drug therapy*; D060046:Maintenance Chemotherapy; D012074:Remission Induction; D012720:Severity of Illness Index; D000067251:Symptom Flare Up
chemical_list: D000305:Adrenal Cortex Hormones; D000974:Antibodies, Antinuclear; D000962:Antimalarials; D007166:Immunosuppressive Agents; D003165:Complement System Proteins; D004247:DNA
keywords: Disease Activity; Outcomes research; Systemic Lupus Erythematosus