title: Disease activity patterns over time in patients with SLE: analysis of the Hopkins Lupus Cohort.
abstract: OBJECTIVE
  To describe SLE disease activity patterns in the Hopkins Lupus Cohort.
  
  
  METHODS
  Disease activity was studied in 1886 patients followed-up for 1-28 years. Disease activity patterns were defined using (1) Physician Global Assessment (PGA) and (2) modified SLE Disease Activity Index (M-SLEDAI) as follows: long quiescent (LQ), M-SLEDAI=0/PGA=0 at all visits; relapsing-remitting (RR), periods of activity (M-SLEDAI>0/PGA>0) interspersed with inactivity (M-SLEDAI=0/PGA=0); chronic active (CA), M-SLEDAI>0/PGA>0 at all visits. The pattern of first 3 consecutive follow-up years was determined in 916 patients as: persistent LQ (pLQ), persistent RR (pRR) and persistent CA (pCA), LQ, RR and CA pattern in each of the 3 years, respectively; mixed, at least two different pattern types were identified.
  
  
  RESULTS
  The RR pattern accounted for the greatest proportion of follow-up time both by M-SLEDAI and PGA, representing 53.8% and 49.9% of total patient-years, respectively. The second most frequent pattern was LQ based on M-SLEDAI (30.7%) and CA based on PGA (40.4%). For the first 3-year intervals, the mixed pattern type was the most common (56.6%). The pRR was the second most frequent (M-SLEDAI 33.3%, PGA 26.5%), while pLQ (M-SLEDAI 6.4%, PGA 0.7%) and pCA were less frequent (M-SLEDAI 3.7%, PGA 16.3%).
  
  
  CONCLUSIONS
  The RR pattern was the most prevalent pattern. LQ was achieved in a subset of patients, using the M-SLEDAI. However, the PGA captured mild activity missed on the M-SLEDAI in these patients. Over a 3-year perspective, less than half of patients maintained their original pattern.
authors.affiliation: ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden.
authors.forename: Noémi
authors.initials: N
authors.lastname: Györi
authors.affiliation: ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Giannakou
authors.affiliation: ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden.
authors.forename: Katerina
authors.initials: K
authors.lastname: Chatzidionysiou
authors.affiliation: Division of Rheumatology , School of Medicine, Johns Hopkins University , Baltimore, MD , USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Magder
authors.affiliation: ClinTRID-Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.affiliation: Division of Rheumatology , School of Medicine, Johns Hopkins University , Baltimore, MD , USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
keywords: Disease Activity; Disease Activity Patterns; Systemic Lupus Erythematosus